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Digitized by the Internet Archive 
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http://www.archive.org/details/bovineobstetricsOObruirich 


BOVINE 
OBSTETRICS 


BY 


M. G. DE BRUIN 


INSTRUCTOR OF OBSTETRICS AT THE STATE VETERINARY SCHOOL IN UTRECHT 


TRANSLATED BY 


W. E. A. WYMAN, M.D.V., VS. 
AUTHOR OF “THE CLINICAL DIAGNOSIS OF LAMENESS IN THE HORSE™; ‘“* DOUBLE 
TIBIO-PERONEAL NEURECTOMY FOR THE RELIEF OF SPAVIN LAMENESS.” 


AUTHORIZED EDITION 


== 


L_—_— =e 








NEw YORK 
WILLIAM R. JENKINS 
851-853 SrxTH AVE. 


1901 


COPYRIGHT, 1901 
By WILLIAM R. JENKINS 


[Registered at Stationers’ Hall, London] 


Printed in the United States of America 


PRINTED BY THE 
PRESS OF WILLIAM R. JENKINS 


New YOrK 


AUTHOR'S PREFACE. 


Within the past decades several works discussing Veter- 
inary Obstetrics have been issued. I refer to the text-books 
of Baumeister-Rueff, Harms, Lanzillotti-Buonsanti, St. Cyr 
and Violet, Sjostedt, Franck-Goring, Fleming and Deneubourg, 
who treated the subject in detail. 

The fact that I had to deal exclusively with bovine obstet- 
rics, induced me to accept Professors Dr. Bayer and Fréhnev’s 
suggestion to write this work. 

A specialized treatise on bovine obstetrics demands a 
rather broad presentation, as it is most frequently met with in 
obstétrical therapy. Taking this fact into consideration, 
certain sections were treated in detail,—for instance, abortion, 
torsion of the uterus, dystokia from malpositions and partu- 
rient paresis. Embryotomy also was fully dealt with, since 
many years of experience have shown me the important réle it 
plays in a bovine obstetrical practice, and an exhibition of the 
various methods, especially in regard to the beginner, are 
desirable. The supplement, “Auxilliaries in the Study of 
Mechanical Obstetrics,’ reviews the manner by which the 
students, in comparatively short time, may acquire some 
dexterity in reposition and embryotomy. 

Most of the illustrations are original; only Figs. 13 and 74 


are taken from Skellet’s work (“ A Practical Treatise on the 
ili 


94088 


iv AUTHOR'S PREFACE 


Parturition of the Cow”); Figs. 16 and 25 I owe to the kind- 
ness of Messrs. Fricker and Frohner. 

As regards the balance, the work must speak for itself. In 
conclusion, I thank all who so kindly aided me in the elabora- 
tion and translation; I also take this opportunity to express 
my profound thanks to Prof. Dr. Frohner for revising the proof 


sheets. 
M. G. DE BRUIN. 


Utrecht, May, 1897. 


TRANSLATOR’S PREFACE. 


When the text book of “ Veterinary Surgery and Ob- 
stetrics,” edited by Profs. Dr. Bayer and Froéhner, with the 
colaboration of the leading authorities and specialists of 
Europe, first presented itself, the importance of an original, 
exhaustive, practical modern discourse, written by eminent 
obstetrical specialists, became apparent. 

Since 1877 and 1895 respectively, the English speaking 
student has been referred to a compilation, to which we all 
bow in thankfulness, fully recognizing the endeavors Professor 
George Fleming made in behalf of the Veterinary Profession 
and stock breeders at that time. 

Since then scientific research has changed many of the 
old theories and given birth to innumerable new facts, playing 
mainly into the field of pathology and therapeutics; for 
instance, the pathology and therapy of abortion, puerperal 
infection, parturient paresis, enzootic diseases of calves, etc. 

The progressive spirit of the publisher, Wm. R. Jenkins, 
whom the profession owes already so much, enables me to 
present to the English speaking Veterinary Profession an 
authorized translation of the “ Bovine Obstetrics” written by 
Professor M. G. de Bruin, who, as a scientist and bovine 
obstetrical specialist, is too well known to require further 


introduction. No apology, therefore, is necessary in offering 
Vv 


vi TRANSLATOR’S PREFACE 


for acceptance the independent obstetrical branch of Profs. 
Dr. Bayer and Frohner’s text book on veterinary surgery and 
obstetrics. Its scope and arrangements, having met the re- 
quirements of European teachers, students and practitioners, 
cannot fail to meet those in English speaking countries. 
Encouraged by the reception given my “ Clinical Diagnosis 
of Lameness in the Horse,” I have devoted limited moments 
of leisure to the translation of the Bayer-Frohner work, being 
confident that Prof. de Bruin’s obstetrical treatise will improve 


obstetrical teaching and reading. 
W. EK. A. WYMAN. 


Milwaukee, Wis. 


CONTENTS. 


PAGE 

ANTOMIN BO) BeASUS 22 8 BA DAN OF De Oe ab orcibTtd Sco On EDO OOOO COCO COOCOOOCHOCn iii 

TEESTAUN SACL OE CS RU PEUA By ic since oleic lols cis Mwicierselelele biel s vislele'siclnisie's sige else Vv 

HORS ATOR os Foo ets NTE Soe AL OU VERN o wb ee bee vii 

AO HODIN ESE DINGS Seca aie ore aoe CET tare cis taravcue aetsleleleia tone wiatele oelsieloe veisele ix 

IN OER IVIEAUI iy Poe GINGAUNCO YS revel se cteitarenchctacisteie Grote ews ole esr erele ee) acctsve sig elere's iL 
I.—CHANGES TAKING PLACE IN THE UTERUS FROM CONCEPTION 

TO DEVELOPMENT OF YOUNG. ..cccccccccccccsccnccccccs 1 

1 —@strum and Conception | 3... ...2-. .2.ce+ esse en ccere ss: 1 

2.—The Process of Evolution of the Uterus................... 7 

Re — GET USP AUN WLS MAGN INDORGIG «05 ehcp cioiohel cic atelealetsj cletcle) vie) sei sielelel eels 15 

je“ hemAmnexesiol thewb Gebusicic cinch o sie cicciseiersielelelercielers = /eiele 15 

2.—The Age of the Foetus...... 2.0... cece ence cere cece ee ceees 23 

Si NIE EI ON OL Nes OobUSaermiemciieeieeicescleaeieieleiere sislelaloieicielar-y 25 

4,—The Intra-Uterine Position of the Foetus.................. 30 

5.—Multiple Pregnancy ...........c0.c0e ceceeee cre nerccesece Ba 

6.—Diagnosis and Differential Diagnosis of Pregnancy........ 30 

(2= Durations Of EreoNanGypecclewisele: sels ciclalolcl= «le elelalel=!n/ ols! ini) 43 

8.—The Influence of Pregnancy on Some Diseases ...........- tt 

9.—Superfecundation and Superfcetation...... NOOO OD CHODOUE 45 

TS Oixavvivsw by LEO RY Be DOM NO GUNES Re os sina dasa sinaogcuaoucosoUdTadaT 46 

eM GENTTAT: PASSAGE) oo <4 ocic Seen neve Cee ha Sect Sy ae RCE 46 

il, Palle (GiniGilbe ceo asnoskes 6 Buco cuticle Ob db bic ou Uno CUS AnOO Ore 46 

2.—The Soft Parts of the Genital Passage............-+-+-+0+- 56 

II.—CavusEs, COURSE AND TREATMENT OF NORMAL BIRTH........ 58 

(-—IbaAlosre irr DinkewasscousuacsdonossuudcouboonQuucuseodeT 60 

De CONTSeLOMNOLMAleoinble seine a cece eile selelelsii cele elsi~c« 63 

ie TNVOLU LON OR THE UMERUStclercteicic ccciceisieo sisieieleieleicelslsie sje eee 81 

PANE N ORIVIBANIE ES MIGUEL twenty ve noes ae a tatara leslie, cleelel esis 9) 0.6 siw/cie o.v\.0,si0 88 

I,.—DISEASES AND ACCIDENTS OF PREGNANCY ......2..c00-ceeeee- 88 


1x 


x CONTENTS 


PAGE 
1;—Circulatory Disturbanensy . if coSi ticdvie ta ween ea wiectsetniacels 88 
2.—Inversion of the Vagina During Pregnancy............... 91 
3.—Paralysis of Gestation, Paraplegia Ante-partum... ....... 99 
4,—Hernia of the Uterus, Hysterocele ..................0-00- 104 
Di —ADOLUEIOMN 5 Si0 ehcfaiisic’ess/atevon le conve: stoustelalel cosisptne foteyatsverteletale rete re stotee 107 

II.—DISEASES OF THE FQ@TUS AND ITS ANNEXES..............00-- 125 

1.—Mummification of the Foetus.............scseesccseccrees 125 

2: —-Ma erations aerveisccraieys ects steeitt ootastee agate one aE oie eee 129 

3.—Anomalies in the Umbilical Cord .................-----+- 132 

4,— Diseases of the Placenta as: .cierm, sctetocaitatalntsiatstohate mate oaaeie ne 132 

5.—Dropsy of the Foetal Membranes................00.ss-008- 135 

Tit —PxTra-UTERINE) PREGNAN GV¢n)-ericisieraeicreicltereionetata cial ale cre ietateitals 140 

ABNORMAT PART URLELLON DiS ORIVAt rr ee eateries 144 

I.—ABNORMALITIES IN THE MOTHER ...........2..0200--s0ees ideas 

1.—Displacement of the Pregnant Uterus .................05. 144 

(a) vAmteversioWibernc: fens cms seteiceiccieematcion menietrrsine 145 

(OD) Dorsioy Witenise cis acc pietelo nities stelerreveiee ice onesie ne ete cee aiete 149 
2.—Abnormalities in the Parturient Passages ..............-. 7 
PelwicsConstriction’s<cmiptcmm cts ercelaciera eke s eieiels eters ote 17 

Morbid Alterations in the Cervix Uteri............... 173 
Abnormalities in the Vagina and Vulva.............. 17 

3.—Abnormalities of the Expelling Power. .................. 181 

IT; —ABNORMALTUINS) OF) WHE GH GH DUS rcierien vaiaielere sicleisterelaiererelercistseteleis 183 

1.—The Foetus Absolutely and Relatively Too Large.......... 183 

2:—Emphysema, of thefPoatusii... os <jo0s e's e vem niciale eaten 189 

3: —Dropsy Of Che Gebus aca. eos ace nisiccievotaliele neta sisters sree eaietees 195 

(a): “Ely droeepitalas ss oii orzo wir cuoterniesn etevelnra ees iat tone 195 

(b) Anasarcea and Ascites..... Rioraialelavsioiwicicntai ev emtaleraveisentontats 197 

4 —Monstrosities «sinicop. ors cise euieio'a's Oe te aisle stninioe aretalee niente ae 200 

OBSTETRICAL, ORBRATIONS ri. etchatetiaterisetseeatieitel stele atelaleteaie siete 208 

E.—OPERATIONS ON ‘THE “PARENT. .:s(c\e) caves clels'sisle's ot '@ s1as elelsieninies's 208 

Li ——Via rinal Ely SbeTOTOMLY)).\a1+/s\tir, + aloter seh slatele/cletotetals ate slat (eletnintetsls 208 

2.-—Artificial ADOrtiOn 2.2 ica voulsieieleia cio totale Ghai aieiniets siatantelsse 211 

SS LAPATOLOM Files. vi vevereieloinistevaictale alate) < connie eiaie is yolera te aetna Te aan este 214 

4,—Czesarean Section, Gastro-Hysterotomia............+se00. 217 

II.—REPOSITIONS AND OPERATIONS ON THE FCRTUS..... ........- 221 

1.—Diagnosis and Correction of Malpositions ..............+++ 221 


2.—Classification of Abnormal Presentations................. 232 


CONTENTS xl 

PAGE 

I, Longitudinal Position....... eheiriesss OB S835 SERA AOR aOTE 234 
1 eA DAODTIN AL POSIDIONS ye isia a: <teiclejeje, Seiserc bisisrele cs isls o's coe OL 

(a) Abnormal Position of One Fore Leg........... 234 

(b) Abnormal Position of Both Fore Legs......... 288 

(c) Abnormal Positions of the Head .............. 240 


(d) Abnormal Positions of the Head and Fore Legs 
(e) The Posterior Extremity of the Body in the 
Parturient Passage and Abnormal Position 
Gf One Hang Mpeg ees pict i biswlewle b:ajhs s'0 esis 
(f) Abnormal Position of Both Hind Legs......... 


D. CostalubresentaiiOnss: <isjamilin canis vie leis eielt sale ce’ 
3 SDorsal Presemuntd@Msiumics sjoalonse ok hele bieiei eel os eieseveie 6s 
Te TANSUCTSE EN CSCHLOLI ONS Hac cnc ois Wis suis  co-e b oie eieie ewe elvis 
i; Transverse: Dorsal Presentations. jac. os cl oa cles rec 
2. Transverse Abdominal Presentation............... 


DISMEMBERING OF THE FETUS (EMBRYOTOMY)............. 


1.—General Rules for Embryotomy .:..........-.-20.00scceeceens 
2 The nstiruments 10M EM Dry OLOMY™ sc: stiecs si rioasios. <n sole 
Partial timbry ObOmmi ost cprmchoce sce ite R seis skier sie oe se 
The Subcutaneous Removal of One Fore Leg in the Pelvic 
Cieaavell aiaccie ovate tech aslo stsl stale Os pre tae o MapsTonae toto ies) 8 Opie neta atoreuaierere 

Removal of the Head (Decapitation) ................ese0e- 

The Subcutaneous Removal of the Head ................... 

The Subcutaneous Removal of One Hind Leg in the Pelvic 


The Subcutaneous Removal of a Fore Leg Retained Under 
thes Abdomen Gh .sis(os es asic cmione saierolwis wlatnehs visleaisieieiais 
The Subcutaneous Removal of a Hind Leg Retained Under 
EHEFA TOMTOM CMe eissssanrsis) eyese eile ou aysileratore alban oils) a | S'Gneley cholslore 
The Turning or Version of the Calf Following Division...... 


Fi — OO DIELS EM DEYOUOMUY ss 2c wicio'e1 oie) d= lw «10 010 so niv mie’s\e)n see nes 
AUXILIARIES IN THE STUDY OF MECHANICAL OBSTETRICS. 


DISEASES DURING AND FOLLOWING THE ACT OF BIRTH... 


1.—Sprains, Luxations and Fractures Following Parturition...... 
2.—Injuries of the Uterus, Vagina and Vulva..................+. 
a ET OUAAHS OF GE -OUOFUS: sawn 'c oincicie-s(oc.cesinc/beineree e tinaies wegu ees 
#—-tetontion of the Atterbirth - 2. jecc coe cicccc coe celecisnnsessaces 
BATT OM EGE UISiereiciaterotcis eco cieleieicyeynteicie) <sisicrsis<icie sieleleve’ ste: lnleielaleisis) «0 

(a) Acute Catarrhall Pndometritis:. 22.5. cr... ce cite cco cine 

CD) mC hronicyENGOMeLIbIS@ acc sce vies ese lowie  <\el<feyees sic sie eens 


Cis) 
oo 
t © 


i) 
’ 
>) 


we 


299 


xil CONTENTS 


PAGE 

6.—Puerperal Infection. .......seeeceeesececceecsereeeeseceecuces 236 
(a) Septic Infection.........ccseceeeeeeerc ere eececcereeenees 236 
1. Puerperal Phlegmion. . 2.2.05 0. 0, eccceccenes ose conese 336 

D. Metritis Septica.... occ .ecs cen cac cence ceeseecsarecces 338 

3. Acute Puerperal Septiczomia ...........e.seeeeeeseeeee 341 
(b) Pyzemic Infection........ceeceeereeee cree cece eeeeeeees 344 
1. Polyarthritis.......ccccscccssceccccecensescnevecccesce 344 
2. Metastatic Synovitis...... .....cccccecepesceenesacess 348 
Se Ghronic ALAM teLuls iets re metelelecrs ete ctete etisalat etre 348 
7.—Puerperal Intoxication............. see cece cece eee ere eeeeeees 350 
(a) Intoxication due to Retained Lochiz.............++.e+e0% 350 

(b) Putrid Puerperal Intoxication.................see scenes 351 
8:—Parturient PAaresis sxc cies su ctels'e vin aon cies e nies oe on cin’s on o's omicleminre 303 
DISEASES OF THE YOUNG CALF... .....cceeecscccceesccecsccccsccccns 368 
1.—Asphyxia Neonatorum....... 0... eee ee ee eee eee e ence ree eneeee 368 
9'—Persistence of the Urachus.......5...ccccscee coccsacccssnecs 370 
3.—Fatal Enzootics of Calves. ...........ccscceccescesccsccsvsccs 371 
(a) Calf Dysentery.........cce-ceceecceceee socceeccecececes 371 

(b) Septic Pleuropneumonia of Calves.........--sseeeseeeees 37 
(c) Calf Septiczeemia (Jensen) .........seeeeeees ee seeeeneceee 375 
(d) Bacterizemia (Hemorrhagic Nephritis and Cystitis) ...... 376 


INDEX.... eee eee eeeee er eee eee teers eset eeeeeeeeeeeetereeeeereeeeeeeeee 379 


A._NORMAL PREGNANCY. 


1 & 


CHANGES TAKING PLACE IN THE UTERUS FROM 
CONCEPTION TO DEVELOPMENT OF YOUNG. 


1.—Cstrum and Conception. 


The development of the young begins as soon as the 
mature ovum comes in contact with the vitalizing fluid. In 
the female an ovum capable of fecundation is only found at 
the age of puberty. 

The age of puberty in the cow varies. In the finely bred 
animal this period may be induced to set in earlier by inten- 
sive feeding, proper care, and careful selection of the parent. 
It even may become inherited, provided the succeeding genera- 
tions live under the same favorable conditions. Puberty of 
the cow is usually present some time before the animal is 
allowed to be served. From the agriculturist’s standpoint, it 
is desirable to have the first calf come in the two-year-old 
female. Some even require the heifer to be three years old 
before she gives birth. A great many points are in favor of 
the latter age. Experience teaches that delivery is easier 
when the pelvis is not too young and the various diameters are 
in proper relation to each other. At the same time cows 
develop better, thus being of greater value in old age, doing 
good service until ten to twelve years old. 

The act of parturition in the two-year-old is often difficult 
on account of the narrow and juvenile pelvis, and the value of 
the cow deteriorates sooner. The dairyman, especially one 
with limited capital, demands the first calf at two years, in 
order to utilize the milk as soon as possible. When fed and 


cared for properly, the disadvantages of an early pregnancy 
1 


2 BOVINE OBSTETRICS 


may be diminished to such an extent as to make this a 
valuable method of breeding. 

The Holstein usually bears the first calf at two to two and 
one half years, when lactation begins. The animal, therefore, 
is served when fifteen to twenty months old. It is not rare— 
in fact, it is the rule—to get three thousand quarts of milk at 
the first lactation, the quantity increasing to six thousand 
quarts and more with the second calf. On an average, the cow 
reaches puberty at ten months. Nevertheless, it may occur at 
five to six months and conception take place. Some years ago 
I performed embryotomy in a thirteen months old heifer. 
The calf was of normal size and too large for this female, and 
for this reason embryotomy was performed. The calf without 
intestines and skin weighed fifty pounds. The heifer stood the 
operation well, and became a good milker. 

The best age to serve the cow may be said to be at 
one and a half to two years. 

During puberty, at certain intervals, ripe ova leave the 
ovary, which, on reaching the Fallopian tube, either are fer- 
tilized or succumb, depending whether coition takes place or 
not. This process, characterized l:y a series of phenomena, is 
known as cestrum. Of the visible signs one may mention: 
The whole behavior changes; the cow runs abouf with the tail 
elevated, bellows and rides other cows; she may leave the 
pasture to get near the bull; appetite as a consequence of the 
excitement is diminished, and the urine is passed in small 
quantities. The local examination reveals hyperzemia of the 
genital organs, especially the vulva; it is swollen, and in 
animals with light skin a slight redness is noticeable. Now 
and then a little blood or reddish mucus flows from the vulva, 
to adhere and coagulate on the long hair of the inferior 
commissure. At times the hemorrhage is considerable, so that 
it may be termed a true menstruation. (Numan.) 

The udder also changes, showing some swelling. During 
the period of lactation the quantity of milk decreases and its 
character changes; it does not churn well and resembles 
colostrum. Occasionally cestrum is only recognized by a small 


(ESTRUM - AND -CONCEPTION 3 


flow of bloody mucus from the vulva; this is known as “still 
bulling.” The beginning of cestrum is indistinct, reaches its 
height in a cow in twenty-four hours, and then declines. At 
the outset of cestrum the female does not take the bull. The 
period of cestrum in the cow is twenty-four to thirty-six hours. 
In case conception does not take place, it repeats itself every 
three weeks. Whenever conception takes place, it is, as a 
rule, wanting during pregnancy. Four weeks after parturition 
cestrum appears. Although no definite time exists for concep- 
tion, it seems to occur more readily in spring. During 
cestrum weak uterine contractions occur, which open the cervix 
sufficiently to permit the introduction of a finger. As a conse- 
quence of these contractions a mummified foetus may be ex- 
pelled. Some cases are on record where a cow was covered 
during the period of cestrum. The following day a dried 
foetus was expelled; nevertheless the animal remained preg- 
nant (Franck). As previously stated, cestrum represents a 
series of symptoms arising from the ovaries and of great 
importance to us. 

At'an early age—in the foetal ovary—the Graafian follicle 
has been proved to exist. During puberty a decided hyper- 
zemia of the ovary occurs, and one or more follicle enlarge and 
project above the ovary, giving the latter the appearance of 
a mulberry, and at this moment “the Graafian follicle is 
matured.” The Graafian follicle bursts, and the ovum is 
received by the fibriated extremity of the oviduct. The 
pavilion of the tube containing non-striated muscular tissue 
grasps the ovary with its fimbrie. 

The ovum is a cell with a diameter of ;'5 to 2; mm., and 
consists of a rather thick and transparent membrane (vitelline 
membrane, zona pellucida), and its contents, the yolk or 
vitellus, made up of a number of granules joined by a viscid 
fluid. The vitellus contains the germinal vesicle and the 
germinal spot. Studies within the last few years show that 
the egg cell undergoes a number of microscopical changes 
before fecundation can take place. 

Corpus Luteum.—When the Graafian follicle ruptures and 


4 BOVINE OBSTETRICS 


empties, a cavity should be formed. Such is actually the 
case, but it is filled immediately with blood from the vessels 
in its wall. It is a hemorrhage per rhexin. ‘The blood 
coagulates, the site of rupture closes, and the coagulum 
becomes incarcerated. The inner lining of the Graafian 
follicle granulates and forms a number of young connective 
tissue cells in the coagulum. The greater part of the 
coagulum is absorbed and replaced by young connective 
tissue. The remaining pigment causes a yellow or orange 
tinge of the connective tissue mass, for which reason the 
body replacing the Graafian follicle is termed “yellow 
body” (corpus luteum). When impregnation follows, and 
thus the periodical hyperemia of the ovum ceases, regres- 
sion of the corpus luteum is manifested, yet it can be 
recognized shortly before gestation ends. When fecunda- 
tion does not take place and periodical ovarian hyperemia 
appears every three weeks, the coagulum is absorbed and 
a little scar tissue forms. The hyperemic condition of the 
genital apparatus is lcoked upon as a reflex act, induced by 
the pressure of the Graafian follicle upon nerve endings 
causing an irritation of the vaso-dilators. This congested 
state causes a mucoid fluid, containing many leucocytes and 
fat globules, to be thrown oft by the mucosa of the Fallopian 
tube. In this liquid the fecundated egg rests. (Franck.) 


CONCEPTION. 


During coition the penis in all probability enters the 
cervical canal, and the semen is poured into the uterine 
cavity. The spermatozoa may reach the egg either by their 
own movement or the antiperistalsis of the uterus and tubes. 
At the moment of ejaculation and already previously the 
uterus contracts, thus narrowing its lumen. Later the uterine 
muscle relaxes, a negative pressure, and aspiration of the 
semen follows, which is now carried to the oviduct by the 
factors already enumerated. 

This is a rather rapid process, as one hour after coition 
spermatozoa can be detected in the Fallopian tube (Franck). 


(STRUM AND CONCEPTION 5 


The egg, having left the ovary and resting in the oviduct, 
on coming in contact with the spermatozoa may now become 
fecundated to undergo various changes. In most cases fecund- 
ation takes place in the pavilion, rarely in the ovary, to be 
discussed later under “ Extra Uterine Pregnancy.” Numerous 
conditions may interfere with impregnation, and sterility 
occurs. Conception, for instance, may be prevented when the 
semen does not meet the ovum; other causes may interfere 
with coition. 

Retention Cyst of the Vulvo-Vaginal Glands (the glands of 
Bartholin).—This cyst, of potato to fist size, is situated on 
the lateral vaginal wall near the labiz, and filled with a 
thick, slimy, brownish fluid containing blackish lumps. This 
obstacle is easily obliterated by incising the cyst wall, after- 
treatment not being necessary. 

Tumors in the vagina interfere with coition. They are 
usually pedunculated leiomymomata, frequently located at the 
inferior vaginal wall of the vaginal portion of the uterus. 

Adhesions of the vaginal walls, resulting from an injury to 
the mucosa of the genital canal, caused by too frequent service 
of the heifer.—Vogt desertbed this affection first in 1878; later 
Harms, in his work on obstetrics. Lately this traumatic 
colpitis has been observed by many veterinarians. By it 
we understand lesion of the mucous membrane and deeper 
layers of the vagina, the result of coition, leading to pus. 
formation, adhesions, or even septicemia. This traumatism 
is mainly seen in heifers running with young bulls. After 
they become impregnated, heat occasionally returns, because 
the fecundated ege succumbs. As a result of repeated coition 
a vaginitis sets in. The patient stands about with arched 
back, the vulva is cedematous, they strain continuously. A 
bloody, slimy, or purulent fluid flows from the vulva; appetite 
and rumination are more or less decreased. The temperature 
is now normal and then elevated. Unless such animals are: 
treated, emaciation takes place shortly, and local examination 
three to four weeks later reveals adhesions of the walls of the 
vagina, and posteriorly to it a thin fluid manifested by fluctua- 


6 BOVINE OBSTETRICS 


tion is noticeable (Pyocolpos). The quantity of pus may 
amount to five or six quarts. 

Early attention results usually in complete recovery. 
The treatment consists of astringent and disinfecting injections. 
Of special value are a 2 per cent. solution of alum, or a i per 
cent. pyoktanin. Should adhesions and accumulations of pus 
be present, the wali is to be perforated with a trocar and the 
opening enlarged with a finger; this is followed by ordinary 
surgical treatment. Hxperience teaches that such animals are 
often of little value as breeders. 

Vaginismus or Elytrospasmus. — From an etymological 
standpoint this name is correct. It indicates a spasm of the 
vaginal constrictor muscle, caused by a hyperasthesia of that 
portion where the vestibule joins the vagina. 

Wagenheuser first observed this affection in the cow. 
According to his opinion, it is a neurosis with abnormal 
irritability of the vaginal inlet, a part richly endowed with 
sensory nerves. In man this diseasewwas first described by 
Marion Sims. This hyperasthesia produces reflexly, by the 
slightest stimulus, contractions of the constrictor cunni muscle, 
even of the pelvic muscles. By it the introduction of the 
penis into the vagina is interfered with. 

The mucosa of the vagina is injected, slightly red, but no 
catarrh is present. If the hand is introduced into the vagina, 
the patient trembles, collapses and falls down. A mere touch 
of that part is often sufficient to bring on these spasmodic 
contractions. 

Similar symptoms accompany micturition. The animal 
crouches with pain, but does not strain. The urine flows 
frequently and in small quantities. Post mortem examination 
does not show any pathological changes in the genital ap- 
paratus. 

One also meets with cases where copulations are not 
followed by conception; the spermatozoa then do not come 
in contact with the ovum. ‘This occurs when the os uteri is 
obstructed, frequently the case in the cow. In consequence of 
the inspissated semi-liquid secretion of the palma plicata, the 


PROCESS OF EVOLUTION OF THE UTERUS 7 


surfaces of the mucous membrane adhere, thus preventing 
fecundation. 

Therapeutics demands the removal of the mucus and the 
opening of the os uteri with the finger or dilator. Sterility 
may also be caused by occlusion of the ovarian extremity of 
the Fallopian tube (Harms), absence of os uteri, uterus 
(Hekmeijer), or chronic endometritis. 


2.—The Process of Evolution of the Uterus. 


As soon as conception takes place the uterus undergoes 
numerous changes, enabling it to fulfil its task, primarily 
noticeable in the mucous membrane. Hypersemia, which sets 
in during cstrum, continues, also increased secretion and 
desquamation. The greater amount of blood causes increased 
metabolism, increased nutrition and hypertrophy of the organ, 
increasing in ratio with the dimensions of the embryo, which 
is known as foetus at the moment cirevJation within it is 
completed. In single pregnancy, the fecundated horn, if twins, 
both cornua usually increase in size. 

As pregnancy advances the uterus increases in size and 
changes its position. In the latter stages it les in the right 
inferior abdominal region, as the rumen extends from the left 
flank to the right lower lateral region. The uterus is related 
on the left to the rumen, on the right it rests against the 
abdominal parietes. The anterior free end, not supported by 
the broad ligaments, is covered by the great omentum. The 
broad ligaments simply enclose the non-pregnant uterus. 
They continue to carry blood vessels to the uterus, which 
often become greatly enlarged; the lumen of the uterine 
artery, for instance, increases four to five times, the smaller 
vessels become quite large and the network of lymph vessels 
expands. The broad ligaments become broader and longer, 
numerous muscular fibres form and unite into broad, muscular 
bands. Increase of size of the uterus is accompanied by a 
very slight decrease in the thickness of its wall, which is 
entirely out of proportion to the increase in size ; thus, hyper- 


8 ' BOVINE OBSTETRICS 


plasia, hypertrophy, or. both. must take place. The outer 
layer of the uterus is formed by the serosa, which may be 
considered of peritoneal origin. The part toward the ab- 
dominal cavity is an endothelial layer; the layer below it is 
united to the muscularis. The muscularis is composed of two 





RN 
Sel heme ana 
Gr a NTN “if 
LUTEAL Cte tem YH 
welll fit 
d \iy 4 | | 

in bY siglo 


SN , 








oe 
Fig. 1.—Sexual Organs of the Cow. 
a, Cavity of the vulva; b, vagina; c, urinary meatus and its valve; d, canals of 


Gaertner: e, external os uteri; f, internal os uteri; g, body of the uterus; 
h, empty horn; i, broad ligament; k, ovary; l, oviduct. 


layers, an outer or longitudinal one, an inner concentric or 
circular one. The former is continued through the os uteri 
into the vagina. During pregnancy the muscular elements of 
the uterus increase in size. 


PROCESS OF EVOLUTION OF THE UTERUS 





Lenerx (LL) anp Wiprs (B) or Muscie Cetts or Bovine UTErvus (IN MICROMILLIMETERS). 










































































Non- At the 14 Days 
pregnant 6 10 12 18 21 51g 8 end of post 
Uterus Weeks Weeks Weeks Weeks Weeks Months | Months |Pregnancy| partum 
SOR | eso Oe ets oud fg Brpatnss eti Avs eeua, areal Mlsygey Poene| cen |murmymsem (teh || ces | ety [Meee || Sey] eh 
83 | 2.8 | 281 | 3.2 | 384| 3.2 | 396 | 3.6 | 576 | 4.0 | 768] 6.4 | 599 | 6.0 | 691 | 4.8 | 714) 6.0) 89} 3.2 
89 | 2 8 | 871 | 2.4 | 460] 4.0 | 460 | 4.0 | 614| 4.8 | 755] 4.8 | 652 | 6.4 | 665) 3.2 | 806 | 6.8 | 204 | 2.8 
89 | 3.2 | 384 | 3.2 | 384] 4.4 | 512] 4.8 | 640 | 3.2 | 832 | 6.0 | 819 | 6.4 | 768 | 6.4 | 652 | 5,2 | 102 | 3.6 
160 | 3.6 | 8307] 3 6 | 448] 3.6 | 471 | 3.2 | 627| 4.0 | 780 | 4.0 | 763 | 4.8 | 819 | 6.0 | 857 | 5.6} 115| 4.4 
89 256 422 524 524 678 678 883 755 128 

102 320 448 550 448 652 599 793 768 140 

140 384 422 652 524 691 704 768 691 76 

115 384 460 691 614 627 844 806 704 64 

108 320 OTL 460 588 742 832 727 742 102 

76 422 448 614 512 883 727 768 844 128 

89 371 422 | 448 409 793 819 793 727 166 

17g. 358 396 537 435 780 780 714 806 Lig 

166 307 409 512 537 806 755 806 665 115 

134 409 435 550 524 832 657 665 704 153 

AVERAGES 
115) 8.1 | 345) 3.1 | 422 3.8 | 524| 8.9 | 537| 40/755) 5.5 | 727 5.9 |755| 5.1) 742| 5.9 ]115| 3.5 |. 

















ass S55 








10 BOVINE OBSTETRICS 


According to Kilian, the increase of volume during preg- 
nancy depends on an increase in numbers and size of the 
muscular elements. Kolliker traces the evolution of the 
uterine muscle in the beginning of gravidity both to hyper- 
plasia and hypertrophy. According to him, the former only 
is of importance after the fifth month. Already at the end of 
the sixth month he found muscle cells of ;4; to } mm. in 
length, in all the layers of the muscularis. 

Reichman measured numerous muscle cells of the gravid 
uterus at various stages in the physiological laboratory of the 
Utrecht Veterinary School. For this purpose he took small 
pieces of the uterine wall of slaughtered pregnant animals and 
removed the mucosa and serosa. The further pregnancy had 
advanced the easier was the isolation of the uterine muscle,— 
in all probability due to an increase of loose connective tissue 
between the layers. The muscle was cut into little pieces of 
7 mm. and macerated in 30 percentic nitric acid; 48 hours 
later rinsed in distilled water, the water renewed and the little 
pieces shaken in it. This isolated the muscle cells the easier 
the further pregnancy had progressed. The muscle cells of 
the empty uterus appear spindle shaped, somewhat swollen in 
the middle while the ends are pointed, the nucleus is long. 
Cells with several nuclei were not observed ; after the twenty- 
first week smaller muscular elements became also noticeable. 
The measurements proved that as pregnancy advances the 
muscle cells increase more in length than in width. Up to the 
twenty-first week both length and thickness increased ; after 
that period the diameter remained stationary. Therefore the 
increase in size of the uterine muscle up to the fifth month 
must be attributed to hypertrophy; later, new muscle cells 
appear, and then only hyperplasia can be spoken of. The 
mucosa undergoes the most important changes, especially 
where the fecundated ovum develops. A new organ is formed, 
or rather a number of new formations arise, the placentie 
materne. These growths, all built alike and forming together 
the placenta, regress after parturition, and the mucous mem- 
brane of the uterus returns to its original state. 


PROCESS OF EVOLUTION OF THE UTERUS TE 


In the non-pregnant uterus, in the Fallopian tube are 
found numerous small prominences resembling scars or warts; 
their color is lighter than that of the uterine mucosa; they are 
of a longish shape, their long axis being at a right angle to the 
long axis of the tube. In cows which have borne several 
calves they are more distinct than in the heifer. These are 
the cotyledons, or caruncul:e ; into their surface the vili of the 
chorion are inserted. During pregnancy follicles form at the 
site of the cotyledons. Each mass of follicles enlarges, 
becomes movable and pedunculated. Since the cow has 





Fig. 2.—Cotyledon of a non-pregnant Uterus, cross section. (Mag. 57). 
a, Ciliated epithelium; b, connective tissue with several cells; c, blood vessels. 


numerous cotyledons in every tube—40 to 60—respectively 
placentse matern, one speaks of a multiple placenta (placenta 
multipla). The cotyledons are convex. Their surface shows 
numerous depressions and is covered with pavement epi- 
thelium. The cotyledons do not contain any muscle tissue: 
this is very important to explain the expulsion of the afterbirth 
in the cow. It will be discussed fully (retention of the after- 
birth) under its proper head. When single placente, respect- 


12 BOVINE OBSTETRICS 


ively cotyledons, are situated about the internal opening of the 
os uteri (orificium uteri internum), a placenta przevia—so 
termed because it is first detected on exploring the cavity—is 
formed (Franck). Besides the larger follicular masses (cotyle- 





Fig. 3.—Pregnant Uterus, with Cotyledons. 
a, Maternal placenta ; b, cervical canal; c, placenta praevia, or accessory cotyledons, 


dons), one also finds a number of mulberry-like prominences 
of the same structure as the placentz uterine, and which are 
also capable of executing the functions of the cotyledons. For 





: PROCESS OF EVOLUTION OF THE UTERUS 13 


this reason they are known as accessory placentw (placentae 





Fig. 4.—Cotyledon of a Pregnant Uterus, cross section. 
a, Blood vessels; b, possibly glands, resembling on first sight the mammary glands, 





Fig. 5.—Uterine Wall with Glands, not pregnant. (Mag. 57.) 


a, Ciliated epithelium; hb, uterine glands (longitudinal section); c, cross section of 
uterine glands; d, blood vessels; e, submucous connective tissue. 
Poa 





14 BOVINE OBSTETRICS 


accessoric). That these placentz really can replace the coty- 
ledons, a case described by St. Cyr and Violet indicates : 

A primipara suffering with prolapsus uteri had nearly all 
the cotyledons destroyed, and in order to prevent hemorrhage 
and infection each cotyledon was ligated and removed. Next 
reposition of the prolapsed uterus was effected, the animal 
recovering shortly. One year later the cow gave birth to a 
healthy calf without assistance. 





Fig. 6.—Uterine Walls with Glands, pregnant. (Mag. 97.) 


a, Mucosa; b, sub-mucosa ; ¢, glands. 


Our literature enumerates several cases where pregnancy 
again occurred after forcible removal of the cotyledons. On 
the surface of the cotyledons union with the chorion takes 
place ; into the depressions of the placentee materne the villi 
of the placente foetalis are inserted. The uterine glands 
(glandule uterine), somewhat wave-like in the non-pregnant 
uterus, enlarge during pregnancy by throwing out bud-like 
processes; the exerctory duct is of a corkscrew shape. 





THE ANNEXSS QF THE FETUS Ps 


LE. 
THE FETUS AND ITS ANNEXES. 
1.—The Annexes of the Fcetus. 


At the moment the product of conception possesses all 
its organs, it is termed a fetus. The foetus is surrounded by 





Fig. 7.—Foetal Membranes. 


a, Amnion; 0, fetal placente, 


its annexes, protecting it against external influences, insuring — 
nutrition and union with the mother. They are: the chorion, 

with the placente foetalis ; the amnion, the allantois, or so-called — 
foetal urinary bladder; the wmbilical vesicle and the umbilical | 


16 BOVINE OBSTETRICS 


cord. 'The foetal membranes are the chorion, amnion and 
allantois. 


THE CHORION. 


The chorion, or vascular membrane, is the outer envelope 
surrounding the foetus and the two inner membranes, and 
adapts itself closely to the outer surface of the mucous mem- 
brane of the uterus. Its inner surface is partly loosely united 
to the outer layer of the allantois and partly closely related to 
the amnion, viz., that portion opposite the back of the foetus. 
It has very many blood vessels, which eventually ramify in 
the placente. 

The chorion has a greater surface than the mucosa of the 
fecundated horns. For this reason it is situated in the non- 
impregnated horn and body of the uterus. When a pregnant 
uterus and contents, for the sake of demonstration, are placed 
upon a table, and the wall of the uterus is carefully incised 
down to the chorion and the incision carried over the whole 
convexity, one notices that the chorion is folded here and 
there and that quite a large piece can be removed from 
the non-impregnated tube. The uterine portion of the chorion 
in the beginning of the foetal period possesses a number 
of dark-brown villi. Between these villi the chorion is smooth 
and transparent. For this reason Franck terms the smooth 
portion chorion levis, and the villous one, chorion villosum. 
Those villi opposite to the cotyledons develop more and more 
to form the foetal placentie (placente fetales); they belong, 
therefore, to the chorion. The foetal and maternal placentie 
are present in equal numbers. They rest upon the chorion, 
non-peduneulated, and each foetal placenta surrounds the 
maternal placenta, its outer surface therefore being concave. 
The size of the foetal placentze varies. The larger ones in the 
highly pregnant animal are 10 cm. long and 5 to 6 em. wide. 
When loosened from the maternal placentze and spread out 
they have a diameter of 14 em. and 7 em. respectively. The 
smallest ones are of the size of a mulberry. 

The foetal placenta is made up of a number of vascular 


Ee 


THE ANNEXES OF THE FHTUS aly 


villi. Each villus consists of a thin connective tissue layer 









Fig. 8.—Chorion Papille. (Mag. 57.) 
a, Blood vessel with red blood corpuscles; b, epithelium; ¢, papille. 


Fig. 9.—Chorion Papilla. (Mag. 1020.) 


a, Epithelium, with capillary vessel; b, white, transparent, bright strip, possibly 
uterine milk. 


and capillary layer, and externally of a layer of pavement 


18 BOVINE OBSTETRICS 


epithelium. Each villus dips into a depression of the mater- 
nal placenta. Since the villi of the latter are similarly 
constructed, it is readily seen that the capillaries of the 
chorion and of the uterine mucous membrane, respectively 
placentz maternz, are separated from each other by a double 
layer of epithelium. (Franck.) 

The placente unite mother and foetus. Of course there is 
no direct vascular communication, but the blood vessels adhere 
intimately to each other, the length and great number of villi 
thus producing an extensive surface. Upon the chorion levis 
—the portion between the placentsz foetales—are found here 
and there agglutination of villi. Franck terms these placente 
accessorie, as they can replace the placentze. In fact, it seems 
when many cotyledons are wanting, these placentz accessorize 
of the chorion can establish union with the same placente 
of the uterus and nourish the foetus. 

Strebel mentions a case where the regular foetal placentz 
of the chorion were absent while the surface was covered with 
villi. These wart-like projections of grain size were red. 
This placenta resembled the one of the mare. Exploration of 
the uterus after parturition showed that its normal cotyledons 
were absent and replaced by analogous elevations representing 
the placentz materne. 


COTYLEDONOUS FLUID, OR UTERINE MILK. 


On the surface of the cotyledons of the cow is found 
a fluid which must be looked upon as an emulsion. It is 
a whitish, reddish emulsion of alkaline or neutral reaction, of 
a specific gravity of 1.036. It contains cylindrical epithelium, 
roundish, multi-nuclear cells, many fine fat globules and salts. 

Gamgee found in 1000 parts of uterine milk: H,Q, 879.1; 
solids, 120.9; albumin with the cells, 104; alkaline albumin- 
ates, 1.6; fats, 12.33; organic salts, 3.74; also kreatin, 
kreatinin and xanthin. 

Colin removed of a calf foetus weighing 5.9 kg. 765 g., and 
of a grown goat foetus 285 gr. (Franck.) 

As to the importance of this fluid, opinions differ. Colin’s 


THE ANNEXES OF THE FQTUS 19 


view—rather improbable—thinks it a post-mortem product of 
decomposition, and denies it any importance. Others consider 
it of great importance in the nutrition of the embryo. This 
opinion is defended by Bonnet, while Franck refers to the 
similar composition of the cotyledonous fluid and colostrum. 
According to Ercolani, the uterine milk is a product of the 
uterine glands; according to others, it follows fatty degenera- 
tion and loosening of the epithelium of the surface of the 
cotyledons. Many investigators have been unable to prove 
the existence of this fluid intra vitam, probably as it is 
immediately absorbed after being secreted. Post-mortem 
examination shows more or less quantities of uterine milk. 

Franck states that possibly some cotyledonous fluid may 
still be formed when the placental circulation stops, viz., after 
death of the mother. At that moment no further absorption 
by the chorion villi can take place, and an accumulation 
of the uterine milk results. 

The greatest mass of the foetal envelope is formed by the 
chorion. Also from a practical standpoint the chorion is of 
importance. Outside of its great importance as to nutrition of 
the foetus, an exact knowledge in regard to the expulsion 
of the afterbirth is necessary. It also plays an important role 
in dropsy of the foetal membranes. 


AMNION, TUNICA OVI INTIMA. 


The amnion is formed by the external layer of the 
blastoderm. Beginning at the navel, it surrounds the foetus 
like a sac, enclosing the latter entirely. This sac contains a 
fluid, the liquor amnit. 

The amnion represents a thin membrane of little resist- 
ance. Its inner surface in ruminants shows numerous little 
yellow projecting spots, named by Claude Bernard, plaques 
glycogénique, as they are composed of glandular tissue capable 
of producing glycogen, thus replacing the function of the liver 
until the latter is completely developed (Joulin, St. Cyr and 
Violet, Traité cd’ Obstétrique). According to Lecoq, they are 
changed parts of the foetal skin, their histological structure 


20 BOVINE OBSTEDRICS 


rather corroborating this view. In fact, microscopical exam- 
ination reveals a close similarity with the skin. These 
plaques are most numerous about the amniotic portion of 
the umbilical cord. 

The external surface of the amnion is partly in contact 
with the allantois, and laterally and at the back of the foetus 
with the face of the chorion. If distended, it is of oval shape, 
but depressed about the umbilicus, giving it a kidney or bean 
shape (F. Lecoq). 

The liquor amnii during the first half of pregnancy in the 
bovine is a thin, amber-colored liquid of alkaline reaction, 
secreted by the internal face of the amnion. The quantity 
increases up to the middle of pregnancy, to decrease from then 
on. Its watery consistency up to the middle of pregnancy 
changes into a mucoid, opalescent, stringy mass. 

Robin (St. Cyr and Violet) gives the following composi- 
tion : 


Belg srcfencia corse iicfoheleiniotaccheboletn el a/etolesetsrnls’s, «reins oielaya pya\nhevel 991-975 parts 
Chlorides, Carbonates. Calcium, Kalium and Natrium 

SUPA HOS 2), Se oie ss wietelstassoreletesr/ehaieinge’e\ © minis a.ehele ole ais 2.60-7.80 
UU Tey eh ease non Drnch cea rane pre eS, Sniabeieyede istenctersisieral ale 2-3.50 
Kreatin, Kreatinin, Sugar and Fat .............+-+. traces of 
Albumen and Mucin........csevccccevsssrecreesces £0.82-10.70 


The amount of liquor amnii at the time o' birth amounts 
up to 4 kg. (Franck). 

The liquor amnii often contains feeces of the foetus, mecon- 
ium giving the liquid a brownish tinge. Kohler found in the 
liquor amnii of a cow, slaughtered on account of a calf too 
large to be delivered, 84 compressed hairballs of a grayish- 
white color. 

Van Klaveren (Holland) reports that he removed an 
enormous calf (duration of pregnancy, 365 days). After 
embryotomy he irrigated the uterus, flushing out loose hair 
and nine hairballs of 5 to 6 em. diameter. The second day 
after parturition he again found seven balls; the third day 
five balls and some more loose hair. In all probability this 
case is analogous with Kohler’s. 


THE ANNEXES OF THE F@TUS 1 


The function of the liquor amnii is to protect the foetus 
against external injuries ; abnormal movements and mechanical 
influences are modified by it to such an extent as to protect 
the foetus against violence. During parturition, on rupture of 
the foetal membrane, it lubricates the vagina and expedites the 
passage of the foetus. 


ALLANTOIS. 


Between the chorion and amnion, as continuation of the 
urachus, lies a sac, which, on account of its sausage shape, is 
termed allantois (aA af, sausage). The urachus forms the 
tube of communication between the allantois and the urinary 
bladder. The external face of the allantois rests against the 
internal face of the chorion. When the isolated and emptied 
sac of the allantois is inflated, a bicornual, irregularly cylin- 
drical sac is formed. The head of the foetus lies in the 
shortest but larger cornu; the longer cornu of less diameter 
forms that portion of the allantois where the posterior ex- 
tremities are. (Lecoq.) 

The allantoid sac contains: The allantoid liquid, the 
foetal urine, which increases toward the end of gestation. 
It is a whitish, foamy, thin liquid of neutral reaction. In the 
beginning of gestation it is colorless ; later, yellow or brownish. 
Its quantity near pregnancy amounts to 8 to 15} 1. 

Robin proved the absence of grape-sugar, oxalates, albu- 
min, mucus and allantoidin in the allantoic liquid. 


UMBILICAL VESICLE (vesicula umbilicalis). 


The umbilical vessel is a provisory organ arising from the 
embryonic gut. It develops rapidly in the first days following 
conception in all mammalia, soon ceases to grow, and finally 
atrophies. 

As soon as the allantois shows itself, it loses its import- 
ance as a nutritive organ of the foetus, since the allantois 
carries the foetal vessels to the chorion, and now, by the 
formation of the placentz, the foetus is nourished from the 
mother. 


pe BOVINE OBSTETRICS 


The umbilical vessicle is a diverticulum of the intestines, 
situated externally to the abdominal cavity. These two com- 
municate through the ductus omphalcentericus. The umbilical 
vesicle of the bovine foetus is reduced to thread size in the 
sixth week. It is of no importance in obstetrics. 


UMBILICAL CORD AND VAGINA UMBILICALIS. 


The navel string (funis) is composed of the urachus, two 
umbilical arteries, two umbilical veins and the remains of the 
umbilical vesicle—the latter of no importance in advanced 
pregnancy. All these are imbedded in a gelatinous mass, the 
so-called “Gelatine of Wharton” (Gelatina Whartoniana). 
This substance is a mucoid tissue, its histological analogue 
being the vitreous humor of the eye. This mucoid tissue 
is difficult to separate from the umbilical cord. The umbilical 
cord’s sheath (vagina wmbilicalis) is a continuation of the 
amnion. At the continuation of the foetal integument a 
distinct line of demarcation is noticeable. The skin of the 
belly continues some centimetres beyond this sheath, this 
portion being known as skin-navel. The external face of the 
sheath shows epithelium and glycogenic plaques, its internal 
face being. covered with endothelium. 

The urachus begins at the fundus of the urinary bladder. 
It lies in Wharton’s Gelatine, and loses itself in the allantois. 
It carries the urine of the bladder into the allantois and is 
still open at the time of birth. 

The umbilical arteries (arteria wmbilicales) spring from the 
internal iliac arteries. They pass along the bladder, help 
to form its round ligaments, embrace the urachus, pass 
through the skin-navel and reach the umbilical cord. Usually 
both umbilical arteries anastomose by transverse communica- 
tion about the middle of the funis. They supply the amnion 
and ramify in the chorion. The smaller vessels go to the 
foetal placenta and ramify in the capillaries which lie in 
the villi of the foetal placenta below the epithelium. The 
umbilical veins (vence umbilicales) arise from the eapillaries 
of the chorial villi, which empty at first into smaller, later 


THE AGE OF THE F@HTUS 23 


larger, branches. These run into two veins at the beginning 
of the umbilical cord, becoming confluent in the umbilical 
ring. The umbilical vein returns to the foetus the blood 
aerated in the placenta; it has no valves. The blood vessels 
of the umbilical cord have a strong muscular wall, therefore 
contracting strongly when ruptured, as is the case at birth. 
The umbilical vessels of the calf are not all adhering to 
the umbilical ring, as is the case in other domestic animals. 
Only the vein is firmly attached. The umbilical arteries are 
united to the surroundings by loose connective tissue, and may 
be moved about in the umbilical ring. On tearing of the 
umbilical cord, they are severed within the abdominal cavity, 
or, rather, the peripheral end retracts within the abdominal 
cavity. (Franck.) 

The flat, longish membrane (8 to 12 em.) seen to hang 
from the navel of newly born calves, consists of the umbilical 
cord’s sheath and umbilical veins. The knowledge of this 
condition is of the greatest moment in the etiology of 
omphalitis. 

In a calf of 30 ke., the length of the umbilical cord was 
21 cm., the length of the calf 98 cm., and the weight of the 
placenta 53 kg. 

The umbilical vessels during the first half of gestation are 
stretched, while in the second half they are slightly twisted. 


2.—The Age of the Feetus. 


The age of the foetus is of importance for several reasons. 
It may be desirable to exactly define it at a forensic examina- 
tion. Also,in premature birth (partus prematurus) the knowl- 
edge of the various sizes of the foetus as regards the period of 
gestation is of great importance. 

Gurlt first gave definite rules enabling deductions as to 
the age of the foetus. He divides pregnancy into seven 
unequal periods. Franck more practically describes the 
changes which take place each month in the foetus. St. Cyr 
and Violet, by using the works. of Chauveau and Arloing, 


24 BOVINE OBSTETRICS 


Colin, Goubeaux and Lanzilotti-Buonsanti, accept Franck’s 
proposition. 

We characterize the various periods of the bovine foetus 
as follows : 

First month: The embryonic period, lasting 28 days. 
The foetus is 9 to 10 mm. long; the first signs of extremities 
appear. 

Second month: This period extends from the 30th to the 
60th day. The extremities develop. The pharyngeal cleft closes 
in the beginning of this month. The sternum still has a longi- 
tudinal fissure in the middle, closing toward the end of the 
eighth week. At the end of the second month one notices 
at the end of each extremity a little conical elevation, which is 
colorless and transparent. This is the first indication of the 
hoof. The length of the foetus is 48 mm. (Gurlt). In the 
ninth week its length is 8 cm. (Lanzilotti-Buonsanti). 

Third month (60th to 90th day): Toward the end of this 
month the four stomachs may be recognized (Gurlt). The 
foetus measures 14 cm. in length. The scrotum is present. 

Fourth month (90th to 120th day): In the beginning of 
the fourth month the hoofs become quite distinct; they are 
firm, non-transparent, and have a yellow color (Colin). The 
foetus is about 24 cm. long and weighs up to 2 kg. (Franck). 

Fifth month (120th to 150th day): In the beginning of the 
month the first tentacule (tactile hairs) appear on the lips, 
chin, upper eyelid, and orbital arch. The teats are plainly 
visible. The testicles descend into the scrotum. The foetus 
is about 35 cm. long and weighs 23 to 3 kg. 

Sixth month (150th to 180th day): The eyelashes are 
more developed. The foetus is about 46 cm. long. The whole 
body is still naked excepting the lips and eyelids. 

Seventh month (180th to 210th day): At the end of 
this month a few long hairs appear at the end of the tail; 
also hairs about the coronet and on the spots where the horns 
appear. The foetus is about 60 em. long. . 

Kighth month (210th to 240th day): The back begins 
to be covered with hair, also along the edges of the ears. The 


NUTRITION OF THE F@TUS 25 


length of the footus toward the 32d week is 65 em. (Gurlt), and 
toward the end of this month 75 em. (Franck). 

In the beginning of the ninth month the whole body 
is covered with hair and increases greatly in size. The foetus 
—measures from 80 to 100 cm. In the beginning of the tenth 
month the foetus becomes mature. 


3.—Nutrition of the Foetus. 


For the development of the ovum, nutritive elements are 
essential. When these are wanting, the egg perishes. Already 
in the ovary the ovum is nourished by the leucocytes; there- 
fore it is reasonable to presume that nutrition after conception 
during the pre-placental period, takes place in this manner. 

Uterine milk, essentially composed of leucocytes in various 
phases, may furnish the food. The cells of the ectoderm 
receive and prepare the nutriment. The material thus received 
first serves to enlarge the resorbing surface by multiplying 
the cells of the ectoderm, and only when this has progressed 
to a certain degree the embryo begins to develop (Bonnet). 

In a later embryonic period the umbilical vesicle, with the 
omphalo-mesenteric vessels, forms. The embryo is nourished 
by the umbilical vesicle—that is, by the smaller branches of 
the omphalo-mesenteric vein (Vena omphalo-mesenterica). The 
heart then carries the nutritious elements to all parts of the 
embryo. 

This early circulation, which might be called the omphalo- 
mesenteric circulation (circulatio omphalo mesenterica), exists, 
same as the umbilical vesicle, only for a time. When the 
latter disappears, and the allantois forms, it is replaced by 
the placental circulation, representing the foetal circulation 
(Fig. 10). By means of this circulation, the blood which 
circulated in the foetus is taken to the foetal placenta and 
reaches the smaller vessels of the chorion. Here its com- 
position experiences changes and then returns to the foetus. 
In the placenta an exchange of oxygen for carbon dioxide 
occurs, the circulation at this part fulfilling the same purpose 


26 BOVINE OBSTETRICS 


as the pulmonary circulation does in the lungs. The venous 
blood in the placenta gives off carbon and takes up oxygen. 
This process is the so-called placental respiration. The blood 
oxygenated in the placenta reaches the fcetus at the umbilical 





Fig, 10.—Schematic Sketch of the Foetal Circulation of a Calf, 
The arrows indicate the direction in which the blood flows. 

A, Heart; B, umbilical opening; ©, portion of the chorion. 1, Anterior aorta; 2, pos- 
terior aorta; 3, anterior vena cava; 4, posterior vena cava; 4, duct of Botalli; 
5!, part of Botalli’s duct posterior to the heart (sketched somewhat too long, 
but was necessary in order to demonstrate it); 6, umbilical arteries; 7, umbilical 
vein; 7!, some of its branches; 8, portal vein; 9, ductus venosus; 10, portal veins; 
11, pulmonary artery; J/', some of its branches; 12, pulmonary veins; 13, tuber- 
culum Loweri; 14, chorion papilla. 


ring by the two umbilical veins. Within the umbilical ring 
the two veins coalesce to form one vessel, which leads to 
the liver (porta hepatica), first giving off a branch (ductus 
Arantii) emptying into the posterior vena cava. The remain- 


NUTRITION OF THE FETUS 27 


ing trunk forms one vessel with the portal vein. At this spot, 
then, the first mixture of the arterial blood of the umbilical 
veins with the hepatic venous blood takes place. The trunk 
of the umbilical veins divides in the liver into numerous 
capillaries, from which finally the hepatic veins arise and 
empty into the posterior vena cava. The arterial blood of 
the umbilical veins, which, on account ot its mixing with 
the vena porte, has been modified in its composition, now 
undergoes a second mixing, namely, with the blood of the 
posterior vena cava. 

Only a part of the blood of the umbilical veins circulates 
through the liver, while another part, as already related, 
empties into the posterior vena cava, via the ductus Arantii. 
Hepatic veins and ductus Arantii finally carry the umbilical 
veins’ blood into the posterior vena cava, and the latter takes 
it to the left auricle of the heart. When the blood arrives 
in the right auricle, it runs through the oval foramen (situated 
in the septum between right and left auricle) into the left 
auricle, the blood current being guided by an eminence, the 
tuberculum Lower. 

During foetal life an oval orifice (foramen ovale) is found 
replaced in the adult by the fossa ovalis. It has a diameter of 
1 em., has an infundibuliform opening into the right auricle, 
and guides the blood carried by the posterior vena cava 
directly into the left auricle. On that side of the septum 
turned toward the left auricle lies the funnel-shaped valve of 
the oval foramen (valvula foraminis ovalis), formed by a fold of 
the endocardium. It is attached to the edge of the oval 
foramen, and its perforated infundibulum projects into the 
left auricle. This valve prevents a return flow of the blood 
from the left into the right auricle. In the left auricle the 
blood coming from the right auricle mixes with the venous 
blood of the pulmonary veins. This mixture is of little 
moment, as the amount of blood flowing through the lungs 
during intrauterine life is a small quantity. From the left 
auricle the foetal blood goes through the auriculo-ventricular 
Opening into the left auricle and on through the aorta to 


28 BOVINE OBSTETRICS 


the various portions of the body. Blood mixtures take place 
at the following places : 

1. At the portal fissure, a confluence of the vena porte 
and arterial blood of the umbilical veins. 

2. At the end of the ductus Arantii, into the posterior 
vena cava, and at the end of the hepatic veins, also into the 
last named. 

3. In the left auricle, a mixing of the pulmonary blood, 
carried by the posterior vena cava from the right to the left 
auricle. The blood of the anterior aorta supplying the 
anterior extremity experiences now uo further change. After 
coursing through the capillaries into the veins, it returns 
through the anterior vena cava to the right auricle. From 
here it gains the right ventricle and pulmonary artery. But 
the greater part flows through Botalli’s duct (ductus Botalli) 
into the posterior aorta. 

The ductus Botalli is a short tube running obliquely from 
left to right and before to behind, and connects the pulmonary 
artery with the posterior aorta. A very small amount of 
the blood reaches the lungs via the pulmonary artery (arteria 
pulmonaris), and from here, after circulating through the 
capillaries, arrives in the left auricle by the left auricle. 

The placenta is the organ of respiration. What the lungs 
are to the breathing animal the placenta is to the foetus. In 
the placenta, more than a simple exchange of carbon for 
oxygen takes place. In all probability, nutritive elements 
pass the placental filter, although apparently during this 
process a modification in the composition occurs. Between 
the villi of the foetal and maternal placenta a thin layer of 
uterine milk is found. One is of the opinion that nutritive 
elements from the capillaries of the uterine mucosa carried 
into the epithelium of the maternal placenta are there changed 
into uterine milk. Bonnet proved that the fat of the uterine 
milk is no product of degeneration, but the result of infil- 
tration. 

The uterine milk, or certain of its constituents, under the 
influence of pressure, are supposed to enter the epithelia of 


NUTRITION OF THE F@TUS 29 


the villi of the chorion, and reach here the blood current 
of the foetus. According to this hypothesis, uterine milk 
plays as important a role in the later foetal periods as at 
the time when the various organs first begin to develop. 

Experiments show that under high pressure white blood 
cells, pigment and bacilli pass the placental filter; under 
ordinary conditions, with moderate pressure, this does not 
occur readily. The baccilus of glanders, tuberculosis, pass 
through that filter, but the anthrax bacillus does not in- 
variably. 

That tubercule bacilli penetrate the placental foetus, the 
various cases of tuberculosis of the bovine foetus reported in 
our literature prove (Bang, Johne, Korevaar, Lungwitz). In 
the case reported by Korevaar, no tuberculosis of the uterus 
was present. 


ANATOMICAL DEVIATIONS OF THE FCQTUS. 


The digestive apparatus of the bovine foetus shows some 
modifications of general interest. 

The abomasum is well developed, and forms the greater 
part of the four receptacles. The rumen is small. The 
intestinal canal is rather short, and contains yellowish or 
greenish fatty faces, termed meconium, small pieces of 
which are occasionally found in the amniotic fluid. The 
liver in the foetus is greatly developed and by far the largest 
organ. 7 

After birth the abomasum and liver decrease in size; 
that is, their volume does not decrease, but their slow growth 
and the rapid development of the others equalizes matters 
soon. 


THE RESPIRATORY APPARATUS. 


The lungs of the foetus are in the state of atelectasis, that 
is, they are devoid of air and their vascular supply is limited. 
In the anterior mediastinum of the foetus between the two 
layers lies a glandular organ, the sweetbread, or thymus 
(glandula thymus). It is already present at the second month 


30 BOVINE OBSTETRICS 


of intra-uterine life, increasing up to birth, and then diminishes 
in size. At birth the thymus of the calf weighs 100 to 200 g. 

According to Ellenberger’s “Anatomy,” the atrophy of 
the thymus is the result of fatty degeneration, gradually 
extending from the surface to the interior, crowding upon the 
follicles and causing atrophy. 

The thymus has a histological structure simulating lymph 
glands, and is counted among the blood glands. 


THE GENITO-URINARY APPARATUS. 


The kidneys of the foetus are large and lobulated. The 
Wolffian bodies, or primordial kidneys, have disappeared at 
birth. The urinary bladder, by means of the urachus, is in 
direct communication with the allantois. At birth, the um- 
bilical cord tears, as also the urachus. The muscular layer of 
the bladder contracts, thus obliterating the entrance into the 
urachus. The testicles at the time of birth are already in the 
scrotum. 


4.—The Intra-Uterine Position of the Foetus. 


In the beginning of pregnancy the foetus floats in the 
amniotic liquid, and therefore does not occupy a distinct 
position. Later, toward the end of gestation, its position is 
more stationary, because the walls of the uterus apply them- 
selves to the foetus. When only one calf is present, it rests 
in one of the uterine horns; when twins, usually each cornu 
harbors one calf. Should both calves arise from the same 
ovum, a common chorion but individual allantois and amnion 
are found. In this case each foetus has its own circulation. 
Observations show that under such conditions both foetuses 
have the same sex. When the foetuses develop from several 
eggs, each has its own chorion, and they are mostly of 
different sex. 

Franck was of the opinion that the foetus has a defined 
position at the outset of pregnancy. In numerous post 
mortem examinations by him of the pregnant uteri of sheep 


MULTIPLE PREGNANCY 31 


and cows, he always found the foetus’ back turned toward 
the convexity of the horn and the belly toward the concavity, 
According to Franck, temporary deviations in the foetal posi- 
tion may occur, but it always returns to its original normal 
position. The calf lies laterally in the right abdomen, with 
its head turned toward the pelvic outlet in such a manner 
that the oblique long axis of the young meets the oblique 
long axis of the mother at an angle of 30 deg. 

The back forms an arch, the limbs rest against each 
other, the forelegs are flexed at the knees and the hindlegs 
point forward. The head is bent toward the sternum. 

Franck, on the strength of his experiments (l.c. 110), 
thinks that the weight of the vertebral column and the exces- 
sive development of the liver induced that position where the 
back was concave. 

It also happens that the posterior extremities of the 
young are turned toward the pelvic inlet of the mother; this 
is the so-called croup or breech presentation. In the cow 
4 to 5 per cent. of posterior presentations occur (Kelhrer). 


5.—Multiple Pregnancy. 


The cow, as a rule, is uniparous—that is, produces one 
young at a birth, although twins are not uncommon. Collin 
(de Wassy) reports a cow which was served twice and brought 
forth three calves, two females and one male, the total weight 
of which was 64 kg. 

Rainard mentions two cases of quadruples. 

Lessona published a case where an 18 year old cow bore 
five calves, three females and two males. They only lived 
eight days. 

Van Klaveren (Holland) reports the following case: A 
four-year-old cow gave birth thirty to thirty-two days before 
her regular time. The animal previously was perfectly well, 
and thirteen days before delivery jumped a wide ditch. She 
expelled at that time two foetuses, one immediately after the 
other; an hour later three more followed. After parturition, 


32 BOVINE OBSTETRICS 


severe uterine contractions set in, which induced the worried 
owner to apply a bandage to prevent an eventual prolapsus. 
Since the contractions increased in severity, the bandage was 
removed and the uterus examined, and a sixth foetus was 
detected, which was born easily. The afterbirth came away in 
proper time. There were two pairs of envelopes, so that three 
foetuses had one common chorion. The foetuses were well 
developed for their age. Three had red, one black and the 
others fawn color; four were males, two females; two foetuses 
weighed each 10 kg., one 11 kg., two each 12 kg., and one 
14kg. The six calves had a total weight of 69 kg. This fertile 
female made a good recovery and remained in good health ever 
since. 

A case of multiple pregnancy is mentioned by Fleming, 
who quotes from MacGillavry. A small polled cow gave birth 
to one calf in 1842, seven in 1843, two in 1844, three in 1845, 
six in 1846, two in 1847, and four in 1848,—altogether twenty- 
five calves in seven years. 

Koch observed seven young in a cow. 

Kleinschmidt reports that a cow which delivered one 
strong calf was slaughtered on account of a serious disease. 
In the uterus and vagina were found fifteen calves. 

In twins, as a rule, each foetus occupies one uterine horn. 
Both usually have a normal position, one the anterior and the 
other the posterior presentation. Harms mentions one case 
where the two foetuses rested in one horn and the uterus. 
The pregnant horn in this case had increased to such an 
extent that the second foetus could not be felt after the first 
one developed. 

Numan noticed that in the bovines the foetuses of multiple 
pregnancy, when of opposite sex, the females, as a rule, are 
sterile, and are known as free martins. This observation has 
been corroborated by many, as Villeroy, Gurlt, Sanson and 
others. They also hold that the same rule holds true with 
the mare, and only the sheep forms an exception to this rule 
(St. Cyr and Violet). 


The above shows that multiple pregnancy in bovines 


DIAGNOSIS OF PREGNANCY 33 


occurs quite often. Many practitioners therefore always 
examine the uterus after delivery to see whether another calf 
is present. This custom is good and ought to be cultivated by 
the young practitioner. At the same time the uterine con- 
tractions of a uterus disturbed by multiple pregnancy are 
weak and short, so that often quite some time passes before 
the envelopes reach the vaginal passage. Owners often try 
to subdue strong pains, fearing a prolapsus, while just these 
contractions are concerned in the expulsion of the unexpected 
foetus. 


6.—Diagnosis and Differential Diagnosis of Pregnancy 


By pregnancy, that state of a female is understood when 
the foetus develops; from a eutokological point of view it is 
also the development of the foetus in the utrrus—graviditus 
uterina. This differentiation is made, as also a pregnancy 
exists, where the foetus does not develop in the uterus 
itself, but externally to it, which shall be discussed later 
on. 

In the previous paragraphs, changes of the position of 
the gravid uterus have already been dealt with. We further 
know that in the uterus and surroundings various changes 
take place. 

The nutrition of the foetus deprives the tissues of the 
mother of constituents which must be replaced, besides that 
gestation considerably modifies the circulation. All this gives 
rise to certain symptoms which lead us to think that the 
animal is pregnant. In a later period, when the foetus moves, 
other symptoms manifest themselves, induced directly by the 
foetus. These especially simplify the diagnosis of pregnancy. 
After conception, respectively fecundation of the ovum, the 
visible changes in the pregnant animal are very limited; 
even after some weeks little is noticeable. One of the first 
symptoms suggestive of pregnancy is caused by the fact that 
no more eggs leave the ovaries periodically, and that the 
symptoms accompanying the process—rutting—do not become 


34 BOVINE OBSTETRICS 


manifest; cestrum in the cow repeats itself every three to four 
weeks. Should cestrum not set in, conception is surmised. 

In many eases this holds true, although some cows rut 
quietly and are overlooked. Besides, it happens at times 
that pregnant cows bull three or four weeks after fecundation, 
take the male, and the cow as a consequence is three or four 
weeks too early, or, rather, the attendant overlooks the fact 
that she conceived at the first coition. 

During the first months of pregnancy the behavior of the 
cow changes some; she avoids galloping, jumping ditches and 
fighting with other cows. Some observers noticed that certain 
cows develop peculiar notions, viz., eat dirt, gnaw stones, 
drink a great deal of water, ete. Some cows when pregnant 
become fat. This symptom is often quite a positive one to the 
owner or attendant. 

An increase in the quantity of blood takes place in 
the second half of gestation as a consequence of the increased 
placental circulation. As a further consequence, the heart 
undergoes greater efforts to supply the parts with blood, 
the heart becomes larger, active dilatation—hypertrophy— 
takes place. This hypertrophy of the heart does not dis- 
appear soon after parturition, but continues for quite a while, 
to become permanent if immediate fecundation occurs. There- 
fore, hypertrophy of the heart is frequently seen in old cows 
who calved yearly. 

It is well known that the horns grow less during preg- 
nancy than otherwise. This alternating increase and decrease 
in the production of horn is recognized by ring formation 
of the horns. The number of rings, therefore, give an ap- 
proximate idea how many periods of pregnancy or how many 
calves the cow had. An unusually large space between two 
rings indicates that the periodical yearly pregnancy was 
missed. Of course one must remember that an alternating 
rich and poor diet, when extending over a period of about 
six months, influences the growth of horn similarly. 

The changed position of the gravid uterus causes a 
dilatation of the right lower region of the belly; it becomes 


DIAGNOSIS OF PREGNANCY 35 


asymmetric. This asymmetry is also seen in some diseases, 
and will be discussed in the differential diagnosis. Toward 
the end of gestation, when the pregnant uterus occupies a great 
portion of the abdominal cavity, the right lower abdominal 
region bulges out materially, the flanks fall in, and the contour 
of the last ribs, transverse processes of the lumbar vertebrie and 
sacrum become plainly visible. As a result of the expansion 
of the belly, the diaphragm is crowded upon during inspira- 
tion and costal respiration the result, and the thorax expands 
more while the abdominal muscles participate less in respira- 
tion. This is plainly visible in old cows; they turn the 
elbows outward to get the assistance during respiration of 
certain muscles common to the anterior limbs. 

Although the increased size of the belly makes pregnancy 
a reasonable, it is nevertheless: not a positive indication ; 
therefore, mensuration of the circumference of the belly is 
of no value. 

The cow during the period of gestation yields a consider- 
able amount of milk. On the one hand, more food is taken in 
to nourish and develop the foetus; on the other, many con- 
stituents leave the body in the form of milk. The milch cow 
has been bred for generations with a view to produce a great 
milker, and has about reached in that respect the physiological 
limit. There exists, as Stockfleth put it rightly, a competition 
between the uterus and udder. Stockfleth deducts from this 
that when the latter is victorious the former succumbs and 
abortion takes place. He believes, therefore, that this physio- 
logical relationship ought to be looked upon as a predisposing 
factor in the frequently occurring abortion of the cow. 

In the milk cow, the udder at times swells several weeks 
before the calf is born. After birth milk secretion rises to 
a certain degree, remains constant, and decreases about two or 
three months before the end of pregnancy. The time between 
cessation of lactation and birth is the period of dryness. Its 
duration may be very variable. Some owners do not wait for 
the time when the milk secretion stops, but discontinue milk- 
ing sooner and dry the animal off. They insist that in this 


36 BOVINE OBSTETRICS 


way the feeding of the milch cow is made easier, and expenses 
diminished, as they do not have to milk her. At this period 
the calf develops most. In most cases the animal goes dry 
two to three months, while in persistent milkers the period of 
dryness is only four weeks. There are also cases where the 
animal milks from calf to calf. 

Shortly before birth, often only in the preparatory stage, 
the so-called springing of the udder takes place. With primi- 
pare, the udder begins to develop two or three months before 
the end of gestation. When this occurs in the two or three 
year old heifer, with no further rutting after coition, one may be 
reasonably certain of pregnancy. In the udder of the primi- 
para one finds, during the second half of gestation, a yellowish, 
viscid, glutinous liquid. Many dealers look upon it as a 
criterion of pregnancy when obtaining such a liquid from a 
heifer. Nevertheless, it is not a positive sign. I have ob- 
served several times that virgin heifers when sucked by calves 
give milk; but the secretion in these instances is not yellow 
and sticky, but white and milky. 

About four to six weeks before the termination of preg- 
nancy, according to Franck, the urine of many cows contains 
albumen, which disappears a few days after birth. Albrecht’s 
investigations are negative in this respect. I have never 
found albumen in urine of pregnant cows, 


EXAMINATION FOR PREGNANCY. 


The presence of pregnancy in the cow is established 
by considering and combining the previously mentioned phe- 
nomena. <A positive diagnosis as to pregnancy can only be 
made by appreciating symptoms induced by the foetus, or 
by local examination. This examination may be an external 
or internal one. 

The external examination comprises palpation of the 
abdomen, foetal movements, examination of the udder and 
obstetric auscultation. 

By palpation we intend to establish the presence of the 
footus in the right lower abdominal region. For this purpose, 


DIAGNOSIS OF PREGNANCY 37 


one stands on the right side of the cow, turning the 
face in that direction. Now the closed fist is placed upon 
the belly in front of the stifle, and executes short inward 
movements. While thus pushing cautiously at intervals one 
feels plainly the resistance of a hard body (provided a fcetus 
is within), and how if returns to its original position after 
having been displaced by the pushing movements of the fist. 
In the beginning of gestation palpation of the abdomen yields 
no results, but in the second half, especially at the fifth or 
sixth month, when the foetal movements are weak, it is a pretty 
good means of diagnosis. This manipulation, also known 
as the palpation of the calf, is employed by many breeders. 

The perception of foetal movements is the best diagnostic 
proof, but they are only palpable in the second half of preg- 
nancy. Of course muscular movements of the foetus occur 
already at the third month, but are too weak to be felt 
through the abdominal wall. About the fifth, or more plainly 
at the sixth month and later, can we perceive these foetal 
movements in the cow. 

For this purpose one occupies the right side of the cow, 
turning the face towards the hindquarters, places the right 
hand upon the back of the animal, the palm and surface of the 
left hand being placed against the abdomen in front of the 
stifle. For this examination much patience is required, as. 
quite some time may pass before foetal movements are appre- 
ciated. In the sixth and seventh month the movements are 
more wave-like and weaker than later, when they are shorter 
but stronger and of a kicking nature. Mistaking it for 
peristalsis is hardly possible after some practice. Toward the 
end of gestation, palpation in lean cows often reveals which 
part of the calf is presented. 

According to some investigators, movements cannot be 
produced by pushing against the abdominal wall. Experience 
at the same time teaches that slight shocks and displacement 
of the foetus encourages foetal movements. It may be said 
that the displacement of the foetus permits of a temporary 
torsion of the umbilical cord on its long axis; as a conse- 


38 BOVINE OBSTETRICS 


quence, the blood vessels are compressed, which induces cir- 
culatory disturbances, and this gives rise to foetal movements. 

We know that accumulation of carbon dioxide and want of 
oxygen in the placental blood, as also arterial anemia of the 
uterus, are capable of bringing about foetal movements. In 
practice, one makes use of it by allowing the cow a draught of 
cold water while examining her. As a result of the entrance 
of a greater amount of cold water, a contraction of the smaller 
arteries and a decreased blood supply to the uterus is pro- 
duced. Severe exertion, as running in the pasture, increases 
the consumption of oxygen, and thus stronger foetal move- 
ments may result. 


EXAMINATION OF THE UDDER. 


In primipare the presence of a sticky, yellowish, viscid 
liquid in the udder makes pregnancy a decided probability. 
The swelling of the udder a few weeks before the expiration 
of her term, points toward pregnancy; besides that, a number 
of phenomena permit an earlier diagnosis. 


OBSTETRICAL AUSCULTATION. 


By it we understand the detection of the foetal heart 
sounds. Mayer of Genf (1818) was the first who observed in 
man the foetal heart-beat on auscultation of the abdomen. 
Kergaradec (1822) differentiates between two important phe- 
nomena on auscultation, viz. heart sounds of the foetus and 
uterine sounds. In man, obstetrical auscultation is a valuable 
auxiliary means for the diagnosis; the life and presence of the 
foetus can thus be established with a great deal of certainty. 
In cows, many tests have been made to define whether 
auscultation of the heart sounds is a practical measure to 
recognize pregnancy. Lafosse of Toulouse was the first to 
communicate in 1857, to have learned the heart-beats of the 
foetus on examining numerous pregnant cows ; it being especi- 
ally marked at the sixth month. In 1857 Hollman published 
that he also observed them. Saake in 1869 contributed the 
details of investigations along that line. He used the stetho- 


DIAGNOSIS OF PREGNANCY 39 


scope, and names as the place for this indirect auscultation the 
right iliac region (regio iliaca dextra), close in front and a little 
to one side of the crural arch (arcus cruralis). This observa- 
tion is arranged as follows: 




















Number of Heart Sounds 
No. Duration of Pregnancy 
| Mother Foetus 
eames 68 146 178 Days (25 Weeks) 
2 84 158 PAU (Se oe we 22!) sae ae 
3 72 162 Dene, (Gilles was 
4 72 128 AL i. (BD. Ah 55 
5 84 150 36 Weeks 
6 74 128 Last Quarter 
7 72 160 A 
8 ? | 168 2 hours before birth 














—————__—____.., 


Saake mentions a case where fracture of the ischium 
was complicated with torsion of the uterus, and where the 
gravid uterus was felt in the left lower abdominal region on 
auscultation of that part, faint foetal heart sounds could be 
detected. 

St. Cyr and Violet heard in two-thirds of all cases 
examined by them foetal heart-beats. They mention also to 
have imagined hearing the foetal heart one day, not to have 
detected it the following day, while some days later again 
the sound became quite perceptive. Eighteen cows closely 
examined by them showed a minimum of 96 and a maximum 
of 154 heart sounds. In one foetus fluctuations from 116 to 
140 were observed. 

Harms says, in reference to the examinations of Saake: 
“T have practiced these examinations repeatedly, but never 
with positive results.”’ 

According to my experience, the heart-beats of the foetus 
may be heard now and then in the right abdominal region 
on auscultation; nevertheless, in numerous cases with well 
marked foetal movements on palpation, auscultation remained 


40 BOVINE OBSTETRICS 


negative. In veterinary practice there are better anchor sheets 
to recognize pregnancy than auscultation. 


INTERNAL EXAMINATION FOR PREGNANCY. 


To prove pregnancy beyond a doubt, the internal exam- 
ination is preferable. By doing so the foetus is felt, thus 
establishing its presence beyond a doubt. Should the exam- 
ination be negative, in the fourth or fifth month of the period 
of gestation, we cannot conclude that the animal is not 
pregnant. A four or five month old foetus in very long cows, 
or those with pendulous abdomen, cannot be reached. In 
other cases again, a four month old foetus can be plainly 
perceived by internal examination. 

The internal examination can be executed in two ways: per 
vaginam and per rectum. The examination per vaginam with 
cows takes place as follows: On examination with the right 
hand, an assistant pulls the tail to the right. The examiner 
stands behind the cow a little toward the left. The hand, the 
nails of which have been trimmed closely, is rubbed with pure 
oil. In between times the assistant washes with soap and 
water the tail and vulva, to prevent, on exploration of the 
vagina, the introduction of feeces, which often adhere to the 
outer surface of the labia. The hand is shaped like a cone, 
and slowly, under rotary movements, enters through the vulva 
into the vestibule. By advancing further, the tips of the 
fingers touch the vaginal portion of the uterus. 

In the pregnant state the cervix is tightly shut and the os 
uteri covered with tenacious mucus (the secretion of the 
mucous folds, palma plicata). In the unimpregnated state the 
cervical canal is also closed, but the mucus layer is less 
adherent and solid. The beginner will find it advisable to 
acquaint himself with the conditions of the vaginal portion of 
the uterus by exploring unimpregnated animals. The calf can 
be felt by vaginal exploration of the pregnant female; but one 
must remember that this is often only possible in well ad- 
vanced gestation. For this reason rectal examination deserves 
the preference. 


DIAGNOSIS OF PREGNANCY 41 


Although one need not fear premature birth (partus pre- 
maturus) as a result of careful and not too frequently repeated 
vaginal exploration, rectal examination is of more use. This 
method gives the best results, and is accompanied with little 
danger. It is employed when external examination leaves 
doubt as to whether pregnancy is present or not. Its execu- 
tion is as follows: An assistant holds the head of the cow 
by means of a halter, standing on the left side of the animal. 
Another person pulls the tail to the right. The operator, 
after oiling the right hand and arm, enters the rectum similarly 
as described for the vaginal examination. The feces are best 
removed. Now the hand and arm are cleansed and again 
introduced into the rectum. Whenever the arm enters up to 
about one half the length of the radius, it is well to locate, at 
the upper wall of the rectum, the promontory. This is 
easily found. Following from here to the right and left the 
linea innominata, the entrance of the pelvis is palpated. 
Below, at the outer border of the pelvis, one finds a sausage- 
shaped mass, the neck of the uterus (cervix uteri). The volar 
surface of the hand, when advanced in a downward direction 
from this point, detects a more or less extensive object, pro- 
vided a foetus is present, conveying the impression as if 
swimming in the abdominal cavity. When pressed upon by 
the hand, it slips away, to immediately return to its original 
position. Closer examination reveals the head and other 
parts of the foetal body. 

From the fifth month on, rectal examination establishes 
pregnancy with certainty. This is also possible before that 
time in many cases, but a negative exploration does not 
necessarily imply that the animal is not pregnant. It has 
happened to experienced practitioners to declare a female 
without calf, while later distinct symptoms of pregnancy 
manifested themselves, the date of the birth showing that the 
animal at the time of the examination had passed one-half of 
the period of gestation. Broholm states that with some 
practice a seven to eight weeks old foetus can be detected. 
One should endeavor to obtain sufficient dexterity on rectal 


42 BOVINE OBSTETRICS 


examination to (1) find the empty uterus; (2) recognize the 
changes of the gravid uterus; and (3) to search for the foetus. 

Toward the end of pregnancy the diagnosis is easy. At 
the seventh or eighth month the position of the calf can be 
established per rectum. At that time a rectal examination is 
usually unnecessary, as foetal movements detected by external 
palpation suffice. In law questions, the examination must be 
complete, and the rectal examination cannot be omitted. 

It is very difficult to diagnose twins in the cow. Simply 
a great circumference of the belly during pregnancy is no 
criterion of twins, as many causes, such as dropsy of the 
foetal membranes, or an excessively large calf, ete., may be 
the cause of it. 

Whenever we feel a calf and foetal movements on the 
right as well as left abdominal walls of the cow, one may be 
reasonably certain of twins. 

In these cases rectal examination is of no great value, 
although it may be in other cases. As to the diagnosis of a 
dead foetus, see ‘Premature Birth” (parlus prematurus). 


DIFFERENTIAL DIAGNOSIS OF PREGNANCY. 


In the diagnosis of pregnancy it is desirable to be ac- 
quainted with those morbid conditions simulating gestation. 
There are many abnormalities in the cow inducing the owner 
to believe that the animal is pregnant. As a close observer, 
he may notice certain phenomena which cause him to think 
that the course is abnormal, for which reason he consults the 
veterinarian. 

One of the diseases in the cow resembling pregnancy is 
dropsy of the belly,—ascites. In these patients the rectal 
examination is decisive. By pushing with the cone-shaped 
hand against the right abdominal wall, the fluctuations of the 
transudation can often be heard; but in cows suffering with 
chronie intestinal catarrh, the liquid intestinal contents may 
produce a similar noise (Harms). Very large tumors may 
lead to mistakes in the diagnosis of pregnancy. Harms met 
with an ovarian tumor in the cow weighing 13 kg. (26 lbs.) 


DURATION OF PREGNANCY 43 


This tumor could be felt on internal and external exploration, 
Bruckmiller mentions in his pathological zootomy that Wolff 
found a fibrous polypus in the uterus of a cow weighing 
200 Ibs. Kehm found in the uterus of a cow supposed to be 
pregnant an atheromatous cyst (steatoma) of 50 lbs. 

At times one finds leiomyoma of great circumference. 
Also, a diffuse, sarcomatous infiltration of the uterine walls may 
result in an enormous increase of size; also tuberculosis of the 
uterus, if it attacks the serous membrane by continuity (Oster- 
tag). All layers of the wall are then infiltrated and enormously 
thickened. Echinococcosis of the liver may enlarge the liver 
to such an extent that it expands the abdomen sufficiently to 
simulate pregnancy (Harms). Palpation of the right ab- 
dominal region behind the last rib, as well as rectal exam- 
ination, with consideration of the other phenomena, are 
sufficient to avoid an error. 

Obesity.—Very fat cows with great abdominal circumfer- 
ence, the result of an undue accumulation of adipose tissue, 
may be thought to be pregnant, especially as the udder also 
becomes enlarged. A simple examination will allow us to 
make a correct diagnosis. 

All these abnormalities resemble pregnancy. A close 
examination can prove the absence of pregnancy, while doubts 
often prevail as to the exact nature of the abnormality. 


7.—Duration of Pregnancy, 


The time elapsing between conception and expulsion of 
the foetus, and during which the calf is fully developed in the 
cow, is about nine months, or thirty-nine to forty weeks. The 
shortest period of gestation, according to Dietrichs, is 210 
-days, the longest 335, the average 286 days (Franck). 

Baumeister and Rueff put the average period of pregnancy 
at 285 days, the shortest 240, the longest 330 days. 

The cows of the “Rijks Veeart-senijschool” at Utrecht 
average 40 weeks, heifers one or two days less. Many factors 
may influence this period. We know that primiparx carry 


44 BOVINE OBSTETRICS 


the calf usually 39 weeks; that is a few days less. Even here 
one finds many exceptions. Generally, one imagines that the 
mother carries a male foetus a little ionger than a female one. 
Also, the age of the mother, heredity and breed may influence 
the length of the period of gestation. 

Literature gives several cases of abnormal pregnancy. 
Servatius reports that a cow was pregnant for 391 days, 
another 371, a third 400, and a fourth 376 days. Clarck 
mentions a case where the period of pregnancy of a cow was 
365 days, and where a living calf of extraordinary size was 
born. Precocity also seems to have some influence. The 
period of pregnancy in highly bred and early maturing breeds 
is shorter (Wilhelm). 


8.—The Infiuence of Pregnancy on Some Diseases. 


It is well known that pregnancy changes the course of 
some diseases; still, we do not know much about this. In 
man, this point is much more important, and its knowledge is 
a great factor to the diagnostician. 

Many diseases run the same course whether an animal is 
pregnant or not. Foot and mouth disease seems to have just 
as little influence upon pregnancy as it has upon the disease. 
But experience teaches that pregnant cows, when suffering 
with anzemia or hydraemia, sooner succumb than in the un- 
impregnated state. The morbid process is increased, as many 
constituents, otherwise retained by the mother, are utilized to 
nourish the foetus. 

Experience in numerous cases shows that cows with 
certain symptoms leading with probability to a diagnosis of 
tuberculosis, look better while pregnant, and apparently gain 
flesh. After birth tuberculosis advanced with gigantic strides, 
thus permitting it to appear as if tuberculosis during gestation 
was latent. 

When osteomalacia occurs in the pregnant female, its 
course is quicker and more serious than in the virgin state. 
It is an old fact, that pregnancy and lactation hasten the 


SUPERFECUNDATION AND SUPERF@TATION 45 


development of this disease. Should lactation cease before 
the end of pregnancy, the patient improves; while six to eight 
weeks after birth the disease becomes extensive (Friedberger 
and Frohner). 

Calves borne by cows suffering with osteomalacia are often 
in good condition, making it appear that lime salts for the 
formation of the osseous frame of the foetus were furnished at 
the expense of the mother. 

Cows in the second half of pregnancy often suffer with 
indigestion; it being rare when they are fed properly. In 
certain localities, however, where for economical reasons a 
voluminous diet, often difficult of digestion, is furnished, 
digestive disturbances in the pregnant animal result. 


. 9.—Superfecundation and Superfcetation. 


By superfecundation is understood the fertilization of two 
or more eggs of one cestrum at short intervals; this making it 
possible that one ovum is fecundated by one bull and the 
other ovum by another bull. At birth the mother bears two 
young created by different males. In the cow this is ex- 
ceedingly rare. 

By superfeetation we understand conception during preg- 
nancy. This has been seen occasionally in the cow. As a 
rule, the second conception induces abortion of the first 
foetus; but it happens that one calf is carried the full term, 
and the other is aborted, that both calves are retained or both 
foetuses are aborted. 


B.—_NORMAL BIRTH—EUTOKIA. 


ile 
THE GENITAL PASSAGE, 


1.—Pelvie Canal. 


The two halves of the pelvis enclose a space, designated 
the pelvic canal, serving the foetus as a passage-way. This 
canal has an inlet, an outlet, a superior, an inferior and two 
lateral planes. 

The inlet is formed by the sacrum, its two wings, the 
internal faces of the iliac and the anterior border of the pelvic 
bones. This anterior opening is shaped like an ellipse, its 
greatest diameter lying under an angle of 45>, and is in 
proportion to the smaller horizontal diameter as 4:3. The 
ellipse is flattened laterally. 

The outlet is formed by the last sacral vertebra and first 
three coccygeal vertebra, posterior ligaments and the ischial 
arch. It is of circular shape ; its plane, although smaller than 
that on the inlet, is capable of expansion. 

The superior plane or roof of the pelvic canal is not 
horizontal, but quite strongly concave, as the result of the 
coneave inferior face of the sacrum; therefore the anterior 
portion of the roof, beginning at the promontory (articular 
head of the first sacral vertebra), rans backward and upward. 
The most posterior portion of the superior plane is formed by 
the bodies of the third and fourth coceygeal vertebrae ; conse- 
quently, the vertical diameter of the outlet varies. The 
inferior plane or floor of the pelvic canal is concave; the 
anterior part, the anterior border of the pelvis, lies about 
4 to 5 em. below the posterior end of the symphysis. The 
line connecting these two points runs from before to behind, 


at first downward and finally upward, forming with a hori- 
46 


THE PELVIC CANAL 47 


zontal plane an angle of 45°. The pelvis, therefore, lies 
much higher posteriorly than anteriorly. The lateral planes 
are formed by the internal surface of the sacro-sciatic liga- 
ments, the internal face of the internal angles of the iliac, the 
internal face of branches of the pubes and ischia. A part of 
the latter also forms the floor. 

The lateral planes being partly formed by bones and 
partly by the pelvic ligaments, they can only expand superiorly. 
From an obstetrical point of view, the pelvic inlet is of the 
greatest importance, as the position during labor of the calf 
must accommodate itself to the shape of this inlet by rotating 
around its long axis. 

The connection between the ossa innominata and the 
vertebral column takes place by means of the sacro-iliac 
articulation. Itis formed by the wings of the sacrum and the 
internal face of the ilinm. The joint permits of but limited 
movement; only during the latter stage of pregnancy, when 
the pelvic ligaments infiltrate and thus become more elastic, 
can we speak of any movement (Franck). From an obstetrical 
standpoint, this joint is very important. In such labor cases 
where a great deal of power is employed to extract the calf, 
an injury to this joint is often the cause of post-partum 
paralysis. The wide pelvic ligaments also unite the sacrum 
and the cox. The union of the innominate bones takes place 
at the pelvic symphysis (symphysis pelvis). The union is 
formed by cartilage, strengthened superiorly and inferiorly by 
short connective tissue and elastic fibres, the lig. arcuatum, 
which runs obliquely across from one pubis to the ischium, 
uniting with the cartilage and periosteum. In young animals 
this union is rather elastic and some little expansions possible, 
but not after the second year. In older animals this symphysis 
ossifies completely, and the middle portion of the pubis and 
ischium, especially round the oval foramen, becomes thinner. 


PELVIC DIMENSIONS. 


Pelvic diameters of the domestic animal, especially the 
horse and cow, have been established same as in man; provided 


48 BOVINE OBSTETRICS 


these data rest upon an anatomical basis, that is, fixed points 
of the pelvic canal, they are of some value. Many diameters, 
considered from a, practical standpoint, are of little importance; 
the relative dimensions of some may be of theoretical and 
practical value. As already mentioned, the inlet of the pelvic 
canal has the shape of an ellipse, lying under an angle of 45°. 


sf 
#8) 
Fig. 11. 
a—b, Vertical diameter of pelvic inlet. c—d, Greatest transverse diameter 
of pelvic inlet. 








Fig. 12.—Section of pelvis with guiding line a-b, 


The long diameter of this ellipse runs from the promontory to 
the symphysis pubis; the short one indicates the greatest 
width of the pelvic inlet, and runs between the ileo-pectineal 
crests. 

Franck terms the long diameter conjugata vera. This 
name may be continued in considering the fact that it thus 
designates this diameter in the human pelvis, although in the 


THE PELVIC CANAL 49 


latter the conjugata represents the short diameter of the pelvic 
inlet. The greatest width of the pelvis is called by Franck the 
middle transverse diameter, or distantia psoadica, Franck 
recognizing besides an inferior transverse diameter extending 
between the pectineal tubercules. This diameter is about 
2 cm. shorter than the greatest width of the pelvis. 

The height of the pelvic inlet (anterior vertical diameter - 
of Franck, diameter sacro-pubien of St. Cyr and Violet) is 
formed by a line resting vertically upon the anterior extremity 
of the ischio-pubic symphysis. This line in the cow touches 
the body of the third sacral vertebra (Fig. 11). On account of 
the concavity of the inferior face of the sacrum, this diameter 
is of considerable size in bovines. In the same manner as in 
the inlet, we distinguish length and width of the pelvic 
passage. The first or vertical diameter of this passage rests 
vertically upon the deepest point of the symphysis, and 
touches the body of the second coccygeal vertebra. The 
width represents the distance between the cotyloid cavities 
(the middle transverse diameter of Franck). It is of little 
value to define the diameters of the outlet on account of its 
expansibility ; only the distance between the postero-external 
angles of the ischium are unchangeable. 

The pelvic axis, also termed line of guidance, is a line 
which the long axis of the foetus follows during parturition 
(Fig. 12). This line is very important, as its course indicates 
in which direction traction should assist the expulsive force. 
This line is obtained by uniting the centres of all lines vertical 
to the symphysis and which come in contact with the inferior 
surface of the sacrum and the first coceygeal vertebra. This 
line runs obliquely upwards at the inlet, descends a little to 
about one-half of the symphysis, and now ascends toward 


the outlet, forming with a horizontal pelvic plane an angle 
of 45°. 


ESTIMATION OF PELVIC DIMENSIONS—PELVIMETRY. 


Pelvic dimensions during life can be ascertained with a 
great deal of accuracy. There are two methods: one by C. 


50 BOVINE OBSTETRICS 


Harms, estimating the size of the diameter of exploration ; the 
other by Arloing, who bases his calculations of the internal 
pelvic dimensions on the distances between certain external 
parts of the body. 


DIMENSIONS OF THE PELVIC INLET OF SOME COWS, EXPRESSED IN 

















CENTIMETERS. 
Number | ah Slay et tea ae NU SG tho ayaa Sa ee Sean 
Distance between | 
promontory and | 
pubic crest..... 94.5 | 28.5128 |24 |24 | 22 | 23 | 25 }22 | 23 
| | | | | 
| } 
Transverse diam- | | | 
Renee eee 18 |17 |16.5|18.8|19 | ig |16.5|17 |17 |16 
Height of pelvic 
TMOG sercdere rose eve 21 21 15 | 20 23 | 20 18 19 19 | iG 











According to Harms’ method, one measures with the palm 
of the hand the distance between the anterior extremity of the 
symphysis and the vertically opposite part of the sacrum ; the 
width or transverse diameter to be estimated by the greater 
distance between the ilia. Knowing the distance between the 
expanded fingers, the height and width of the pelvis can be 
ascertained. 

I practice pelvimetry according to this method as follows: 
The cone-shaped hand enters the vagina. Palpation detects, 
superiorly, the anterior promontory; inferiorly, the anterior 
extremity of the ischio-pubic symphysis. Making a quarter 
turn with the hand, one rests the little finger upon the anterior 
extremity of the symphysis; the other four fingers are closed 
and the thumb is stretched out toward the roof; now one 
attempts to touch the sacrum with the thumb without re- 
moving the little finger from the symphysis. In this way the 
height of the inlet is estimated. Following the linea innomi- 
nata, the little finger is turned toward the right until the region 


THE PELVIC CANAL 51 


of the transverse diameter is reached. Now the hand, with 
its dorsal surface superiorly, is in a horizontal position. Next, 
the thumb and little finger are extended, to ascertain approxi- 
mately whether the pelvic inlet has the normal shape or not. 
Thus one can investigate the pelvic dimensions by previously 
measuring the distances between the extended thumb and 
little finger or thumb and index finger respectively. Also, the 
distance between the cotyloid cavities can thus be calculated, 
and a stenosis recognized. 

Diameters estimated after this method are always smaller 
than in reality. Especially the calculation of the vertical 
pelvic diameter is made difficult on account of the recto- 
vaginal excavation (excavatio recto-vaginalis). (St. Cyr and 
Violet.) 

St. Cyr and Violet, employing Arloing’s method, who 
established the diameters of the equine pelvis, calculated the 
diameter of the bovine pelvic inlet by distances measurable on 
the external surface of the living animal. According to their 
investigation, the height of the pelvic inlet (diameter sacro- 
pubien) equals 0.180 times the height of the animal at the 
withers, allowing an additional 5 to 15 mm. above and below. 
My observations show that in the Holsteins this coefficient 1s 
0.15, allowing even an additional 1.5 cm. 

he greatest pelvic width they calculated by multiplying 
with 0.36 the distance between the external ilial angles. Here 
also an additional 5 to 15 mm. is permissible. The circum- 
ference of the pelvic inlet, according to these estimates, equals 
3.44 times the average sum of the diameters ascertained for the 
pelvic inlet. 
ced + cd —2 
2) 2 

2 

= —______—__X 3.44 
2 


In some animals examined by me I found the following 
diameters (expressed in centimeters) : 


52 BOVINE OBSTELRICS 











| Distance be- 
Distance be- tween 
Height tween promontory Height ' Greatest 
at external and | and of width of 
Number withers ilia angle pubic crest pelvic inlet pelvic inlet 
1 126 49 23 19 16 
2 127 55 24 20 18.3 
3 135 56 24 | 21 18.5 
4 130 55 22 20 17.5 
5 125 49 23 18 16 
6 129 51 25 19 16.5 
i 127 50 22 19 16.5 
8 125 48 23 17 15.5 
9 182 53 26 21 7.5 
10 129 52 25 20 17.5 

















DIFFERENCES THE RESULT OF AGE. 


The pelvis of a two year old heifer differs materially from 
that. of an adult. It is of practical interest to describe a 
young or juvenile pelvis. In the bovines, ossification of the 
diaphysis with the epiphysis of the ilium only occurs at the age 
of two and a half years. In contradistinction to the solipeds, 
ossification in the bovines is from behind to before, so that 
there is first firm union of the ischium with the posterior 
branch of the pubis, and then pubic union (St. Cyr and 
Violet). 

In a two-year-old heifer the symphysis is not yet ossified ; 
this explains the fact, frequently seen in practice, that a heifer 
stands the forcible extraction of a calf better than a grown 
cow. How often does it not happen that eight to ten people 
together extract a calf from a heifer, or that other barbarous 
means are employed—for instance, a wagon wheel or lever— 
and that the owner reports a favorable termination. Such a 
happy course must be attributed, first, to the wanting ossifica- 
tion of the symphysis, and, second, to the elasticity of the 
juvenile pelvis, permitting of a slight transverse expansion. 

The pelvis of a two-year-old heifer differs from a grown 
one as follows: The wings of the sacrum are shorter and 
narrower. The greatest width of the pelvis is less, the inlet is 


THE PELVIC CANAL bo 


compressed laterally, especially about the lower segment. The 
line drawn from the posterior iliac angle to the symphysis 
runs more perpendicularly. The pelvic passage also is nar- 
rower from side to side. We know that the plane running 
through the cotyloid cavities is least capable of expansion. 
For this reason the passage of the foetus may be retarded. 
The normally developed calf may be too large for such pelvic 
dimensions, to prevent extraction. Such a calf is known as 
relatively too large. These cases call usually for embryotomy. 
As age advances pelvic dimensions change and the pelvic canal 
widens. Therefore, an abnormal birth in a two-year-old, as 
just described, does not mean an unfavorable prognosis for the 
cow as a future breeder. 

The pelvis of the calf is very elastic and compressible. 
As a consequence, a calf may be born alive although the 
distance between the trochanters exceeds the transverse pelvic 
diameter of the mother. 


THE IMPORTANCE OF PELVIC DIMENSIONS IN OBSTETRICAL PRACTICE. 


In man, an exact estimation of the pelvic dimensions is 
often of the greatest importance. The prognosis as to the 
course of labor in a patient with an abnormal pelvis can only 
be made after its diameters have been ascertained. It may 
become necessary during pregnancy when fear exists that the 
present pelvic deviations would not permit of a normal 
delivery, and in order to save the mother’s life artificial 
abortion might be indicated (rachitic pelvis). 

In the cow, lessening of the pelvic diameters is not very 
frequent. Malformations in man producing stenosis quite 
frequently lead to an examination, but are exceedingly rare 
in the cow. Animals with such abnormalities are not bred. 
Nevertheless, it is desirable that the veterinarian be acquainted 
with pelvimetry, for these reasons : 

1. The relationship between the diameters allows us to 
form an idea of the shape and position of the pelvic bones and 
contour of the pelvic canal. 


54 BOVINE OBSTETRICS 


2. A knowledge of these dimensions allows us to under- 
stand the mechanism of parturition better, and shows how the 
foetus accommodates itself to the pelvic inlet. Discussion of 
the mechanism of parturition later will show how the calf gets 
through the inlet. Let it be mentioned here, that during 
expulsion the head, resting upon the forelegs, lies in the 
vagina, the sterno-dorsal diameter of the calf’s thorax runs 
parallel with the vertical line, starting from the symphysis, the 
diameter of which is greater than the transverse diameter of 
the inlet, which runs parallel with the smaller bicostal diameter 
of the thorax. 

‘This, therefore, is favorable for the passage of the foetus, 
although the dimensions become somewhat modified, as the 
ribs are pushed back on the thorax and can be compressed 
decidedly. 

3. The practice of pelvimetry becomes necessary when 
during pregnancy stenosis is present, be it the result of 
fractures, formation of exostoses or dislocation of the sacrum. 

During gestation, disturbances may be present or arise, 
inducing changes in pelvic dimensions. Fracture of the 
external angle of the ilium, quite common, does not produce 
pelvic stenosis; but fracture of the internal ilial angle or shaft 
of the ilium may do so; the dislocation, as well as the callus 
following it, may diminish the transverse diameter of the inlet. 
Fractures of the pubis and ischium may also lessen the pelvic 
diameters by callus formation. 

Descent of the sacrum resulting from rupture of the 
ligamentous apparatus between it and the ilium, may materi- 
ally decrease the height of the pelvic inlet. This dislocation 
is not accompanied by a disturbance in the union of the 
sacrum and last lumbar vertebra, but the most posterior 
portion of the vertebral column is lowered. The internal iliac 
angle projects, and one feels the tensely stretched longis- 
simus dorsi. This condition is usually the result of dystokia, 
where the calf was extracted forcibly. The cow remains down 
for days or weeks after such a labor, arises then with great 
difficulty and remains quietly in the stable; when put out on 


THE PELVIC CANAL 55 


pasture in spring a swaying walk behind is noticeable for 
quite some time, which gradually improves until the animal is 
again served and impregnated. The sacrum stays in its 
abnormal position, as the wings are fastened by new connec- 
tive tissue, which gradually becomes tendinous. In such 
animals the height of the pelvic inlet is decidedly decreased 
(Stockfleth). 

In the year 1894 such a cow was presented here at the 
ambulatory clinic. She was pregnant for seven months and 
the sacrum had sunk completely between the internal iliac 
angles. On examination, the height of the pelvic inlet was 
12 em., while in the normal state it should have been from 19 
to 20 cm. a 

For the owner’s interest I considered it best to await the 
normal end of pregnancy, and to render assistance during 
parturition by performing a partial or complete embryotomy. 
The reasons inducing me to do so were: (a) milk production is 
_ better when the animal does the regular time than if abortion 
takes place; (b) the risks connected with artificial abortion; 
(c) the little danger of embryotomy. 

Two months later ‘the cow was again examined during 
labor pains, and since the circumference of the calf prevented 
its extraction in toto, embryotomy was performed. After re- 
moving the anterior limbs subcutaneously, the head just went 
through the inlet. The operation was finished in the ordinary 
manner. Four days later the cow went out to grass. 

4, Indications furnished by pelvimetry during the act of 
parturition. 

This refers equally to extractions in normal and abnormal 
presentations. The knowledge of the pelvic diameters enables 
the operator to compare the dimensions of the calf with the 
greatest pelvic diameter and thus make birth easier. 

I shall mention here an example. It often happens that 
when one half of the calf is born (head, neck and anterior 
limbs), the posterior extremity cannot glide through the inlet, 
as the calf’s sacrum catches the mother’s sacrum ; here slight 
torsion of the calf suffices to extract it with but little exertion. 


56 BOVINE OBSTETRICS 


Many experienced stock owners know how to correct this 
abnormality, by fixing the calf and placing the cow in a dorsal 
position, when but litte traction delivers the calf. The knowl- 
edge of pelvimetry explains to us what these people empiric- 
ally but successfully executed. 

By giving the calf a quarter turn, the trochanteric dia- 
meter of the calf is rendered parallel to the vertical diameter 
of the inlet; in other words, the greatest diameter of the hind 
quarters of the calf pass through the greatest diameter of the 
pelvic inlet. 

The knowledge of pelvimetry explains many theoretical 
and practical data, and while the latter is not immediately 
perceived, its practical value cannot be denied. Many a little 
trick applied by the experienced obstetrician, and which in 
certain cases is of great use, is not thought of by the beginner. 
The practice of this vocation demands great circumspection 
on the part of the veterinarian and is surrounded by peculiar 
difficulties; for this reason nothing should be omitted which 
would enhance his theoretical, and especially practical, know- 
ledge. 


2.—The Soft Parts of the Genital Passage. 


In describing the process of evolution, the changes in 
the texture and position of the uterus were discussed. The 
canal which the foetus must follow during expulsion, commonly 
termed genital passage, at the time of birth differs so much 
from that of the unimpregnated state, as to demand a detailed 
discourse. 

The walls of the pelvie canal, the form and dimension of 
which have just been described, surround mainly the rectum, 
urinary bladder and vagina. When the rectum is empty—as 
is the rule during parturition—it having been emptied by 
repeated defecation in the preparatory period, its walls col- 
lapse, leaving but a limited space between them. Besides 
that, the concavity of the inferior face of the sacrum is sufti- 
ciently deep to receive the rectal walls without materially 
decreasing the vertical pelvic dimensions. 


THE SOFT PARTS OF THE GENITAL PASSAGE 57 

The urinary bladder rests upon the floor of the pelvis. 
When emptied, it lies on the more elevated portion of the 
pelvic floor; when filled, it reaches up to, or even beyond, the 
anterior pubic border. It usually does not interfere with the 
passage of the foetus either during eutokia or dystokia, being 
- mostly emptied in the preparatory period. 

The reflectory contractions of the muscularis of the 
rectum and detrusor muscle of the bladder are of physio- 
logical importance in preparing the genital passage. 

The internal wall of the genital passage is principally 
formed by the vagina and vestibule. Since they fill the pelvic 
cavity, the abdominal cavity is practically closed by them. In 
speaking of the uterus, it was stated that its attachment 
depends on two folds of the peritoneum, termed mesometrium. 
(Fig. 1.) 

From the upper face of the uterus the peritoneum runs 
posteriorly to the vagina, turns upward and forward, to end in 
the serous lining of the rectum. The peritoneal fold thus 
formed has a space between its two layers communicating with 
the abdominal cavity, known as the reclo-uterine or recto-vaginal 
excavation. That part of the mesometrium, respectively peri- 
toneum, lining the lower face of the womb, runs also toward 
the vagina, about to the meatus urinarius, turning then down- 
ward and forward, covering the upper face of the urinary 
bladder. These vesico-vaginal folds enclose a space also con- 
necting with the abdominal cavity, and termed the vesico- 
uterine excavation. : 

Both excavations play an important role in the etiology 
of the prolapsus vagine and prolapsus vesice. This shows 
that only the anterior part of the vagina has a serous covering ; 
its outer line posteriorly is an adventitia, composed of con- 
nective tissue and elastic fibres. This adventitia connects 
above the vagina with the rectum and below with the visceral 
layer of the pelvic fascia. Laterally, the adventitia joins the 
coccygeal muscles and pelvic fascia. 

The vagina is least elastic where it becomes the vestibule, 
as certain muscles of that region end in a fibrous layer, 


58 BOVINE OBSTETRICS 


which might be looked upon as the deep perineal fascia, viz.: 
the perineal muscles, the sphincter of the anus, the depres- 
sor of the tail, the retractor of the vagina, and some muscular 
fasciculi extending between the broad ligaments and vulva. 

As a consequence of these anatomical conditions, the 
expulsion of the calf experiences some obstacle at this spot; 
the dilatation of the vaginal walls is painful, on account of the 
numerous sensory nerves. 

The vaginal wall further consists of a muscularis and 
mucosa. The muscularis shows externally longitudinal, in- 
ternally circular fibres, increasing in number at the vestibule, 
which represents the thickest portion of the muscular layer. 
Between both layers are numerous elastic and fibrous fasciculi. 
The internal surface of the genital passage 1s a mucosa. 
Beginning at the spot where the foetus develops, and up to the 
vulva, viz., the whole tract through which the calf passes, we 
find a dilatable wall, the inner surface of which is lined with a 
mucous layer. In the unimpregnated state, the cervix uteri 
lies in the pelvic cavity or upon the anterior pubic border, but 
during advanced pregnancy in the abdominal cavity. That 
part of the cervix uteri extending into the vagina, known as 
the vaginal portion of the uterus, remains firmly closed during 
pregnancy. The anatomical arrangement of the cervix uteri 
permits it to be opened to such an extent that the body of the 
uterus and vagina form a common canal. As a consequence 
of the elasticity of the walls, it is possible to obtain an 
amount of dilatation only limited by the bony canal. 


Il. 
CAUSES, COURSE AND TREATMENT OF NORMAL 
BIRTH. 


Whenever the foetus has reached full maturity, it is ex- 
pelled. This ends intra-uterine life, and extra-uterine life 
begins. This course, subject to many deviations, including 
mother and foetus, is termed birth or partus, the act itself 


CAUSES, COURSE AND TREATMENT OF NORMAL BIKTH 59 


inducing birth-parturitio. Parturition is a physiological process, 
which may take place without unfavorable sequels for mother 
and foetus, yet may produce many organic changes, which, in 
themselves normal, predispose to diseases and disturbances ; 
therefore, to keep away evil influences, a prophylaxis is only 
successful where a thorough knowledge of the changes aud 
mechanism of parturition exists. As the end of gestation 
approaches, certain phenomena announce the birth of the 
young animal. 

What causes birth to occur at a definite time ? 

Many theories are offered in explanation. Some believe 
that the developed foetus acts as a foreign body; others that 
the fatty degeneration of the epithelium of the placenta plays 
an important role; again, others base their hypothesis upon a 
certain analogy existing between stomach, rectum and bladder. 
The latter organs, which serve as a reservoir, by the aceumu- 
lation of their contents expand the contractile walls to an 
extent resulting eventually in relaxation of the sphincter and 
periodic evacuation. In the same manner the enlarging foetus 
causes a relaxation of the uterine sphincter, the uterine walls 
contract and expel the foetus (St. Cyr and Violet). 

Smith (1848) identified physiological processes with 
cestrum and parturition. 

Brown-Séquard alludes to the fact that the excitability of 
the uterus increases with advancing pregnancy; the presence 
of carbon dioxide in the maternal circulation, according to him, 
acts as a powerful excitant, producing uterine contractions. 

Obernier combines the theories of different authors, and 
says: “Each period of menstruation excites uterine contrac- 
tions, the tenth one sufficient to produce expulsions, the 
uterine nerves being at that time in a hyperesthetic state.” 
It is his opinion that the cause of birth in man is found in the 
occurrence of the tenth menstrual fluxion (Kelhrer). 

Franck was of the opinion that the same conditions 
prevail in the lower animals. He also believed that the acute 
genital hyperemia of cestrum is identical in the causation of 
labor pains. 


60 BOVINE OBSTETRICS 


Many observations corroborate these theories; for in- 
stance, the occurrence of an abortion just at a time when 
in the unimpregnated state cestrum would set in; the expul- 
sion of a so-called calf mummy during the period of cestrum. 

Franck found, on conducting a post mortem of cows which 
died during or after parturition, one or more matured Graaffian 
vesicles almost ready to rupture in the ovary devoid of the 
corpus luteum. This led him to the deduction that the ovary 
which did not furnish the impregnated ovum might create 
reflectorily a genital hyperzemia by the pressure of the swollen 
vesicles upon the sensory nerves, same as during cestrum. 
According to Ellenberger, the act of birth, the changes which 
the gravid uterus undergoes, as well as the periodical expul- 
sive contractions following fecundation, are simply hereditary. 


1.—Labor Pains—Dolores. 


Generally speaking, the words “labor pains” represent 
the expulsive forces; in a more concrete sense, the uterine 
contractions. The contractions begin in the muscles of the 
broad ligaments, next contracts the uterus, and in the further 
course of parturition the muscular elements of the vagina and 
vestibule participate. These contractions are periodical; they 
occur now and then, with definite intermissions. 

Various causes induce uterine contractions. The uterus 
may contract as the result of irritations originating in the 
cerebellum, medulla oblongata and spinal cord (Spiegelberg, 
Frankenhauser, Korner, Obernier); but the uterus itself 
harbors nerve centres, stimulation of which produces con- 
tractions. Sensibility is conducted via the spinal nerves. 
We already stated that advanced pregnancy means a hyper- 
zesthetic state of the uterus. Excitability of the uterus also 
increases with rise of temperature and hyperemia of this 
organ. We further know that dyspnoic blood—that is, blood 
Jaden with carbon dioxide and wanting in oxygen—is exciting 
to the uterus. In all probability the stimulus leading to 
contraction arises in the uterine nerve centres. Mechanical 


LABOR PAINS’ 61 


influences may also cause uterine contraction, which will be 
discussed fully under ‘‘ Abortion.” 

As a result of uterine contraction the placental circulation 
is lessened and a small amount of blood enters the placenta. 
During the labor pains the foetal heart-beats become slower. 
One looks upon this as an excess of carbon dioxide in the foetal 
blood. The increasing frequency of the maternal heart-beat 
during labor pains causes a rise of pressure in the arterial 
system—a compensation, to a certain extent, for the limited 
amount of blood following narrowing of the arterial channels 
(Kehrer). The contractions of the uterus are not of a peris- 
taltic nature, as the whole contractile surface acts together. 
The pressure following labor pains is considerable. 

Poullet ascertained the intensity of labor pains mano- 
metrically by an apparatus termed by him “ 'Tocograph.” 
This instrument transfers the pressure, the result of the 
uterine contraction during labor pains, to a manometer, which 
records it upon a rotating roll of paper—that is, in the same 
manner as we produce pulse and respiratory curves. The 
apparatus of Poullet consists of, first, a strong but compres- 
sible caoutchoue ball; the ball is introduced into the uterus, 
between its walls and the foetal envelopes, when the latter are 
torn between the uterine walls and body of the foetus. Second, 
it consists of a mercury manometer, a U-shaped tube, partly 
filled with mercury, and one arm of which communicates with 
the ball by means of a caoutchoue tube, while the other arm 
has a float, the end of which is provided with a pen to 
register the movements of the mercury. When the apparatus 
is started without introducing the caoutchouc ball into the 
uterus, the pen records upon the rotating paper a horizontal 
line, termed zero. On introducing the ball in the proper 
manner into the uterus during labor pains, and connecting it 
with the apparatus, the water in the ball becomes compressed 
and the pressure is transferred to the mercury, causing it to 
rise in that arm of the U tube with which the ball is con- 
nected. During the intermission the mercury falls, registering 
a horizontal line. Each intermission produces the same hori- 


62 BOVINE OBSTETRICS 


zontal line. Poullet called it the line of tonic uterine con- 
traction. In the cow this line is 44 to 48 mm. above zero, and 
shows no fluctuations (St. Cyr and Violet). In the woman, the 
uterus during the periods of intermission is almost at rest, the 
line being nearly horizontal; the line of tonic uterine con- 
traction in the woman is 15 to 20 mm. above zero. As soon 
as contractions begin, the mercury column constantly rises 
and falls until a period of rest occurs. 

A labor pain is made up of a series of momentary 
contractions, followed by relaxation and diminution of uterine 
tension. Each contraction produces a rise of mercury from 
80 to 110 mm. (St. Cyr and Violet). By means of the toco- 
graph, we may measure the force exerted by the contracting 
uterus and the movements of its auxiliary muscles, viz.: 
abdominal compression. 

Each cubic centimeter of the foetus experiences during 
a strong contraction a pressure of 200 to 300 er. (St. Cyr and 
Violet). When the surface of the calf, barring the extremities 
—that is, up to the patelle and elbows—represents 32 din.’, 
the calf receives a pressure of 6410 to 960 kg. During violent 
throes—that is, a continuous tonie contraction, known as 
tetanus uteri—the uterus becomes anemic, resulting possibly 
in asphyxia of the foetus. Should a torsion of the uterus or a 
closed os uteri be present, or the expulsion of the foetus 
retarded ou account of its excessive size or abnormal position, 
labor pains are unsuccessful, and in due time uterine fatigue 
sets in. When the contractions after exhaustive labor are 
weak and of short duration, one speaks of an atony of the 
uterus ; while limited uterine contractions, with a long period 
of rest, are termed an inert uterus. Total absence of contrac- 
tions are the result of exhaustion or paralysis of the uterus. 

Labor pains, according to their effects, are divided into; 
(1) Preparatory pains; (2) expulsive or labor pains; (3) post 
partum pains. 

Preliminary stage-—Preparatory pains are such uterine 
contractions where the abdominal pressure is limited. These 
pains loosen a portion of the foetal placenta and open the 


COURSE OF NORMAL BIRTH 63 


cervix uteri; following this, they assist in rotation of the 
foetus. 

Stage of Expulsion—LExpulsive pains are strong, and their 
intensity is greatly assisted by the auxiliary abdominal 
muscles. The intermissions are here short. The muscles of 
the vagina and vestibule contract reflexly, seen by the periodic 
retraction of anus and vulva. Immediately after birth these 
contractions decrease in intensity. 

Post partum stage expels the after-birth, they are less 
strong and have long periods of rest. Normally, the abdom- 
inal muscles are not concerned in the production of post 
partum contractions, but occasionally the uterine contractions 
are assisted by them. Especially are those cows exposed to 
severe post partum pains which lie with the hind quarters 
lower than with the anterior extremities. 


2.—Course of Normal Birth. . 


How do we know in the cow that birth is approaching ? 

While dealing with the phenomena of pregnancy, I already 
hinted at the fact that certain signs manifest themselves, 
especially in the last month of gestation. The swelling of the 
udder, beginning three to four weeks before birth, is one of 
the most important symptoms; also the nature of the lacteal 
secretions indicates approaching birth. As long as the milk 
is watery and thin, birth of the calf is not imminent; but 
when milk is whitish-yellow and colostrum-like, it soon 
occurs. 

To define the time of birth is necessarily of great import- 
ance to the stock-owner. With him it becomes a habit to 
visit a cow about to calf every night before retiring, in order 
to see whether she ought to be watched that night or not. 
Many men become very accurate in this respect by practice, 
but even the most experienced one will err. I myself have 
seen a calf born within two hours, while a careful survey pre- 
viously made did not indicate an immediate delivery. 

Experience teaches us that the end of gestation and the 


64 BOVINE OBSTETRICS 


beginuing of parturition is characterized by certain prodromes 
pertaining to the preliminary stage. 

1. Fulling in of the Pelvic Ligaments.—By placing the hand 
laterally to the tail upon the posterior border of the sacro- 
ischiatic ligaments, we notice that they become indistinct. or, as 
it is termed, they have fallen in. 

The relaxation of these is not exclusively the result of 
infiltration, but also depends on mechanical causes (Berdez, 
Schweiz. Archiv., 1882, p. 188). The relaxation, according to 
Berdez, follows the approach of the ischial tuberosities and 
the roof of the pelvic cavity, the latter due to a rocking move- 
ment of the pelvis. As soon as the contractions of the uterus 
relieve the severe tension of the abdominal parietes, the pelvis 
rises posteriorly. The antagonists of the rectus abdominis 
allow the pelvis to drop a little anteriorly, thus bringing the 
ischial tuberosities closer toward the sacrum, and the ligaments 
relax. This explains also why the pelvic ligaments may sink 
in decidedly within a few hours. 

The position of the pelvis shortly before birth is obliquely 
downward and forward. As a consequence, the gradual slope 
of the floor of the pelvis toward the lower abdominal region 
assists the act of parturition (Berdez). 

Some cows, as the result of a previous dystokia, when old, 
tuberculous and cachectic, have relaxed ligaments; in them 
this symptom is of ne value during approaching labor. 

2. Swelling of the Udder.—The sudden filling with milk is a 
phenomenon heralding the end of gestation. Already since 
the beginning of the last month the udder gradually increases ; 
at the end of the period of pregnancy it remains stationary for 
some days, when now suddenly the udder swells considerably 
and the early birth of a calf may be expected. 

In some cows the swelling of the udder becomes so enor- 
mous as to worry the owner. The tumefaction may extend 
posteriorly up to the vulva and anteriorly to the sternum. 
The udder may be strutting with milk to such an extent that 
the owner empties it. This procedure is not objectionable 
from a hygienic standpoint; in fact, it is to be recommended 


COURSE OF NORMAL BIRTH 65 


in such cows, irrespective of the objections raised by the 
owner. 

3. Falling in of the Flanks.—This is very plainly visible 
laterally to the transverse processes of the lumbar vertebrie 
and behind the last ribs. The contour of the lumbar vertebrie 
and sacrum appears much sharper. 

4. The Discharge of Mucus from the Vulva.—The cervix 
uteri closes because its plicated folds come together. By the 
secretion of a glairy, viscid white mucus, depositing itself like a 
stopper upon these folds, the uterine opening is firmly guarded. 
As a result of a very limited dilatation of the cervix uteri one or 
two days before birth, this glairy mucus begins to lose hold, 
and often appears in long and thick filaments at the vulva. 
Oceasionally this mucus is slightly red in color, caused by a 
little blood from the chorion and some of the accessory coty- 
ledons near the internal uterine opening. 

5. Swelling of the Vulva.—Physiological tumefaction of the 
vulva oceurs in the last days of pregnancy. It is caused by an 
active hyperemia, reflexly instituted by the ovaries. This 
swelling is not always present. In some cows it is wanting 
while present to a great extent in others, and termed edema 
of the vulva. 

The preliminary or preparatory stage is followed by dila- 
tation of the os uteri. The cow, which up to this time stood, 
or laid down from time to time, becomes uneasy, paddles 
behind, whisks the tail, defecates and micturates frequently 
and in small quantities, ies down and rises often. The uterine 
contractions, previously quite weak, now increase in intensity ; 
now and then a throe is assisted by the abdominal muscles. 
The presence of the dilatory throes is recognized by the clonic 
contractions of the perineum; the muscles which retract the 
superior wall of the vagina when the tail is fixed, are also 
actively concerned. During these contractions of the uterus 
the cervix uteri becomes dilated. What causes dilation of the 
os uteri? In the first place, the contractions of the uterus, 
cervix and vagina. The dilatation thus affected, and which 
might be termed an active one, is nevertheless limited and far 


66 BOVINE OBSTETRICS 


from being sufficient. After the cervix is once open’ further 
dilatation is continued from within the uterus, and therefore is 
a passive one. 

By the contractions of this stage, a portion of the chorion, 
which lies close to the inner opening of the cervix uteri, is 
detached from the maternal placentz and is pushed forward in 
the shape of a bladder by the allantoic fluid, which is under 
high pressure. As a result of the pressure exerted by this 
bladder against the internal uterine opening and its adaption 
to the form of the cervical canal, dilatation slowly pro- 
gresses. 

Anatomy teaches us that the mucous folds (palme plicatze) 
of the cervix uteri lie in such a way that the uterus may be 
probed from within to without, but not vice versa. AS soon as 
the cervix uteri is somewhat dilated, the secretion of the palmez 
plicatee advances into and beyond the vagina,—thus corrobor- 
ating the anatomical peculiarity just mentioned. In this stage, 
therefore, we see long viscid streams of mucus appear at the 
vulva. The cervix is gradually dilated by that segment of the 
envelopes filled with the foetal liquor. An examination per 
vaginam at this stage reveals the globular fluctuating foetal 
envelope, completely filling the whole vagina. 

We term it the water-bag, since it contains foetal fluids. 
This water-bag is composed of the chorion and allantois con- 
taining the allantoic fluid, but since the chorion is less elastic 
than the allantois, and held firmly by the placenta, the former 
ruptures already on passing through the cervical canal, so that 
the water bag finally consists only of the allantois. 

At the end of this stage the cervix uteri has widened to such 
an extent that the vagina and uterus form a common cavity. 
At the end of this stage the intensity of the contractions 
increase. The previous statements permit of the deduction 
that the water-bag must necessarily advance as far as the 
vagina—yes, even beyond the vulva—to sufficiently dilate the 
genital canal. It does not only dilate the cervix uteri, but also 
the vagina; therefore it prepares the canal for the passage of 
the foetus. 


COURSE OF NORMAL BIRTH O7 


In order to have birth take a regular course, it is of import- 
ance that this bladder should not rupture within the genital 
passage. When the water-bag reaches the vulva, it appears as a 
bright glistening tumor of more or less bluish tinge, separating 
the vaginal lips. In the further course this bladder appears 
beyond the vulva as large as a head, and often bursts as the 
cow rises. 


STAGE OF EXPULSION. 


At the moment when the water-bag ruptures, be it the 
result of violent pains or manual interference, a part of the 
allantoic fluid escapes. This is called the rupturing of the 
‘water-bag. The uterine muscle acts directly upon the foetus as 
soon as the allantoic fluid enters the pelvic canal, especially 
after this fluid escapes. The uterine contractions change the 
position of the calf. The intrauterine costal presentation is 
changed into an abdominal one, the head and forelegs becoming 
extended at the same time. The contractions introduce the 
young animal into the pelvic canal with its head lying upon the 
anterior limbs. As an immediate consequence of the rupture 
of the allantoic bladder, rotation of the foetus about its long 
axis takes place. 

The amnion is pushed forward in the shape of a bladder. 
The allantoic bladder has already prepared the passage for 
this bladder, within which the foetus and forelegs rest. A few 
strong pains, assisted by abdominal pressure, and the amniotic 
bladder plus foetus are forced into the vagina. As soon as this 
bladder manifests itself between the lips of the vagina, it likens 
the allantoic bladder exactly. Its color is whitish, glistening. 
The claws are visible through the thin, transparent amnion. 
Strong throes advance the calf further and further ; the amni- 
otic bladder bursts, followed by an escape of viscid, slimy, 
opalescent amniotic fluid. The nature of the escaping liquor 
permits us to recognize whether the amniotic or allantoic 
bladder has ruptured. As soon as the amniotic bladder bursts, 
violent throes drive the foetus, lying on its abdomen, through 
the pelvic canal. . 


68 BOVINE ODSTETRICS 


After the anterior extremities have passed the pelvic inlet 
and the head is born, the uterus contracts upon the hind 


‘YMG [BUION— ET “SMT 


*(2][218) 





' quarters, and, with the aid of the abdominal compressors, the 
foetus is expelled. 
The genital canal offers two parts where the passage of 


COURSE OF NORMAL BIRTH 69 


the foetus may meet with obstacles, viz.: the cervix uteri and 
where the vagina runs into the vestibule. The former does 
not interfere, provided it is fully dilated. In primipare it 
often happens that the cervix uteri is not sufficiently opened, 
and the foetus is detained slightly at that spot. We proved 
previously that this is partly caused by the early rupturing of 
the allantoic bladder within the cervix uteri. 

The vagina is slightly contracted where it runs into the 
vestibule. Here also the moving foetus meets occasionally 
with difficulties and detention. At this spot the passage of the 
calf is extremely painful, on account of its great supply with 
sensory nerves. Birth is often retarded at this place, especially 
in primipare. 


FETAL DIMENSIONS WHICH MUST CORRESPOND WITH PELVIC 
DIMENSIONS TO PERMIT NORMAL BIRTH. 


The following dimensions of the foetus demand considera- 
tion : 

1. The transverse diameter of the head, or the bitemporal 
line, which is quite pronounced in the calf, must be smaller 
than the greatest width of the pelvic inlet or passage. 

2. The vertical diameter of the head, as well as the diameter 
of the carpus, must not be greater than the height of the pelvic 
inlet. The vertical diameter of the pelvic passage and outlet 
do not offer difficulties. The vertical diameter of the pelvic 
canal is greater than the one of the inlet, on account of the 
convexity of the os sacrum and concavity of the pelvie floor, 
while the outlet is expansible in an upward direction by the 
mobility of the coccygeal vertebree. 

3. The vertical diameter of the thorax (sterno-dorsal 
diameter) is always greater in the matured calf than the height 
of the inlet, while the bicostal diameter plus both shoulders is 
smaller than the greatest pelvic width. Nevertheless, normal 
birth may occur, as the ribs, by accommodating themselves to 
the pelvic inlet, are pushed back. In this manner the vertical 
thoracic diameter is lessened materially, without increasing the 
bicostal diameter. Asa result of the backward movement of 


70 BOVINE OBSTETRICS 


the ribs, the vertical diameter of the thorax may be decreased 
by 6cm. When the withers of the calf once pass the inlet, its 
further passage becomes much easier. 

4. The distance between the two external iliac angles in 
most cases is smaller than the greatest transverse pelvic 
diameter. The hind-quarters of the calf often apparently get 
caught after the anterior half is already born. This is 
not always the consequence of incompatible dimensions, 
examination revealing that both iliac angles have passed the 
pelvic inlet. 

5. The distance between the trochanters, also known as 
the bicoxal diameter, in order that the course be a normal one, 
must not exceed the greatest width of the inlet or transverse 
diameter of the maternal pelvic canal. 

6. The distance between the two patelle is especially great 
in meaty calves. When greater than the transverse pelvic 
diameter, birth is retarded. It will be fully discussed in the 
chapter on the “ Relatively Too Large Feetus.” 

At birth, the anterior or head presentation is most common. 
Here the chest lies opposite to the pelvic inlet. Anterior 
presentations are the rule in the cow; of course, breech or 
posterior presentations, where the croup faces the inlet and the 
calf is born hind legs first, also occur. The intrauterine posi- 
tion of this breech presentation is a costal one; that is, the 
foetal back is turned toward the right abdominal wall of the 
mother, the head toward the flexed carpi, while the hind legs 
are flexed at the hocks, the two hocks pointing toward the 
pelvic inlet. Here also a rotation of the calf around its long 
axis takes place ; as soon as the cervix dilates, the water-bag 
enters the genital passage and the water partly escapes. By 
this rotation the calf's back comes opposite to the mother’s 
spinal column and the inferior face of its abdomen is turned 
toward the maternal abdomen; the hind legs, extended and 
surrounded by the amniotic bladder, which they propel, pass 
into the cervix uteri. 

During the expulsive pains, the hind quarters pass the 
pelvic inlet first, then the thorax, and finally the head. 


COURSE OF NORMAL BIRTH 7a 


Although parturition often terminates favorably, nevertheless 
the posterior presentation frequently gives rise to dystokia. 

We noticed already that dilatation of the cervix uteri 
depends on the pressure exerted upon the internal opening of 
the cervix, by the segment of the chorion and allantois filled 
with foetal liquor. This factor is also prominent in a birth with 
posterior presentation. As the result of the extension of the 
hind legs, the chorion-allantoic bladder is immediately followed 
by the amniotic bladder, which contains the claws of the hind 
feet and which now glide: easily into the cervix uteri. But as 
the calf’s pelvis presents itself before the inlet, the dilatation 
caused by the water-bag is often insufficient to permit the 
passage of the foetal pelvis, and expulsion is thus interfered 
with. In the anterior presentation the larger amniotic bladder 
containing head and fore legs produces complete dilatation. 
The contractions now increase in violence, and since the cervix 
is now dilated mechanically by the foetus, this obstacle may be 
soon removed. After the hind-quarters are born, thorax and 
head meet with no difficulties. Those complications which 
may yet arise will be discussed later. 

During normal birth, with either anterior or posterior 
presentation, the calf lies in a postero-anterior plane ; primary 
transverse presentations do not occur in the cow. The intra- 
uterine position of the calf is the result of its accommodation 
to the form of the uterus. The back of the calf lies toward the 
convexity of the uterus. The largest portion of the calf, its 
hind-quarters, lies in the most roomy part of the horn, the head 
in the narrower part and in the body of the uterus. This 
theory, also called the accommodation theory, readily explains 
why a head presentation in the cow is the rule. 

In man, one tries to explain frequency of the head presen- 
tations by the fact that the point of gravity is nearer to the 
head than to the breech or lower extremities. This theory— 
gravity-theory—has also been applied to explain the frequently 
occurring anterior presentations in the uniparous mamalia. 
(Battlehner, Kehrer, l.c. page 105). 


72 BOVINE OBSTETRICS 


THE TREATMENT OF NORMAL PARTURITION. 


It may happen that the veterinarian is called to super- 
intend a case of normal parturition in the cow. The practi- 
tioner under such circumstances would observe many a 
thing with which the beginner, of course, should acquaint 
himself. 

Provide sufficient room and a soft bedding when the first 
signs of approaching parturition announce themselves. Suffi- 
cient room is easily obtained by removing cows on the right 
and left. Since the cow moves about, lies down and rises during 
the preliminary stage, more room is required. In stables where 
we find behind the stall a gutter for feeces and urine, a board is 
best placed upon it, which may be looked upon as an elonga- 
tion of the stall. This board is covered with straw. Now the 
hind legs of the cow cannot step into the gutter nor can they 
suddenly slip into it during violent throes. 

At each birth sufficient assistance and material should be 
present. By sufficient help I mean that two strong persons 
besides the obstetrician are ready to assist in traction when 
such is indicated. As sufficient material I designate : two or 
three ropes; two round sticks, each 32 em. long and 4 em. in 
diameter, being a little thicker in the middle than at their ends ; 
500 g. linseed oil, soap, lukewarm water and some towels. In 
some cases, when the udder is so enormously swollen that the 
cow cannot lie down, it may become necessary to empty the 
udder. This often renders the previously excited animal quiet, 
and the act of parturition begins. 

For the present nothing else is necessary but to watch the 
animal. The preparatory stage may be a long one in the cow, 
in some cases half a day and more; in some animals this stage 
occasionally escapes our observation, as the cervix uteri is 
already dilated on our arrival. Cases of slow parturition or a 
prolonged preliminary stage should not worry us too quickly. 
When it extends over more than four hours, an exploration per 
yaginam, under proper precautions, to ascertain the state of 
the cervix, may be instituted. 


COURSE OF NORMAL BIRTH 73 


The water-bag, so important in the dilation of the genital 
passage, must not be ruptured until the genital passage is fully 
dilated, so that all folds of the neck of the womb have dis- 
appeared. It usually ruptures when meeting with resistance 
in the genital passage or when protruding at the vulva. A part 
of the foetal liquor then escapes. Shortly after it is followed 
by the amniotic bladder. The time between the two may be 
short—ten to fifteen minutes—but may amount to several hours. 
During the pains, quite intense at this stage, the cow rests 
most comfortably upon the right side. I have often observed 
that it is very uncomfortable for the cow to lie upon the left 
side and that she rises immediately. The position of the rumen 
explains sufficiently why lying upon the left side when con- 
tinued for some time creates tympanites and dyspnoea. In 
cases of very large foetus, or twins causing great distention of 
the belly, parturition always should take place on the right 
side. 

Even during normal parturition the act is retarded, when 
the amniotic bladder, advanced by the head lying in the shape 
of a wedge upon the fore legs and passing through the genital 
canal, appears between the lips of the vulva. It is due to the 
resistance offered in the vestibule to the dimension of the head, 
both its bitemporal and vertical diameter. The passage is 
here very painful. While overcoming this obstacie the animal 
issues an expiratory moaning, or may even bellow. When the 
head is visible between the labiz and past the vestibule, both 
fore legs arrive beyond the vulva up to the carpi. Now the 
amniotic bladder bursts, the fluid escapes, and, unless the calf 
is very large, a few expulsive pains suffice to expel it com- 
pletely. It gradually has become a habit to open the amniotic 
bladder in order to extract the calf. The amniotic bladder 
must be opened when the legs up to the carpi and the head as 
far as the eyes are visible beyond the labiz, in order to prevent 
complications following an eventual inspiration of the calf. As 
soon as parturition has advanced to this effect, the placental 
circulation ceases, be it because the umbilical cord has torn by 
having been pinched at the pelvic floor, or because pressure 


74 BOVINE OBSTETRICS 


put an end to this blood supply. However, at the moment 
when this occurs respiration begins, which, when the amnion 
is closed, induces deglutition of the amniotic fluid. After the 
amniotic bladder has ruptured, the expulsive forces may be 
assisted by gentle traction. 

Since it is hardly possible to pull sufficiently with the 
hands on account of the slippery skin, ropes fastened to the 
pasterns by means of a loop, and wrapped around a stick at its 
free end to prevent them from cutting the hands, are employed. 
Attention must be paid that no foetal envelopes enter between 
the loop and the shinbone. 

How strong shall traction be and in which direction is it to 
be exerted ? 

Many owners have the bad habit of opening the amniotic 
bladder, and rope the fetlocks and extract the calf as soon as 
the claws of the fore-legs appear at the vulva. There is no 
reason for such hurry. Nor need one fear that the calf will 
asphyxiate after the amniotic bladder ruptures; but there is 
danger to rupture the upper border of the vestibule when 
traction is employed too early and too strongly. Only when 
the muffle appears between the vulva may traction upon the 
fore-legs be practiced. The force developed by one or two men 
suffices in normal parturition. When the head is born, the act 
of parturition ceases for a moment as the withers pass and as 
the trochanteric diameter passes through the maternal pelvic 
inlet. 

Primipare at the age of two years often experience difticul- 
ties as the trochanters of the calf pass between the cotyloid 
cavities of the mother. Pelvimetry showed that the juvenile 
pelvis is deficient in its transverse diameter of the pelvic canal. 

In which direction is traction to be exerted ? 

When traction is employed, it must be exerted in the same 
direction in which expulsion takes place. As the calf enters 
the pelvic canal, traction is to be exerted in the direction of 
the os sacrum ; as it passes through the canal one pulls in the 
opposite direction, while upward traction is indicated as the 
calf leaves the genital passage. 


COURSE OF NORMAL BIRTH TD 


Traction on the calf and labor pains must occur synchro- 
nously. It is senseless and dangerous to pull during the 
intermission. The obstetrician recognizes a pain by the bulg- 
ing of the left flank, provided the animal lies on its right side ; 
traction at that time is doubly effective. 

Normal parturition with a posterior presentation, where 
the hind-legs enter the pelvic canal first, requires a little 
different treatment. 

The amniotic bladder is pushed into the vagina by the 
hind-legs ; here the claws of the posterior limbs can be seen 
already before the cervix is fully dilated. On complete rota- 
tion, the back of the calf lies against the spinal column of the 
mother, the fetlocks point toward the sacrum and the plantar 
surface of the hind claws upwards. The uterine contractions 
occasionally advance the hind-legs as far as the fetlocks. In 
this case the amniotic bladder must be ruptured and parturition 
assisted by gentle traction. 

In this presentation there is constant danger of rupturing 
the umbilical cord in consequence of this intrauterine respira- 
tion of the calf, aspiration of amniotic liquid and suffocation. 
Under these circumstances itis desirable to hasten parturition 
to save the calf. 

The above shows that aid in normal parturition principally 
consists in preventing complications. We know from experi- 
ence, that when the water-bag is ruptured too early the soft 
genital passage is insufficiently dilated, and, in consequence of 
traction on the calf, injuries of the cervix and vaginal walls may 
arise. In primipare, where parturition is often very slow, we 
must always try to prevent ruptures of the above-named parts, 
and especially the perineum. In such a case the use of lubri- 
cants, as, for instance, oil, is indicated. This procedure is a 
favorite one with many breeders. 

The question is often raised whether it is necessary to 
explore in normal parturition. 

If the course is perfectly normal, it is advisable to 
abstain from exploring the parts; but, just as soon as an 
abnormality manifests itself, the genital passage must be 


76 BOVINE OBSTETRICS 


examined. But the following must be remembered as regards 
infection : 

The perinzeum, the labiz and surroundings, as also the 
tail, are to be thoroughly cleansed with soap and luke- 
warm water. It is well to do this at the outset of parturi- 
tion, although micturition and defecation during the pre- 
paratory stage may require a second cleansing. The tail 
is held to one side by an assistant. The obstetrician 
washes hands and arms with soap and warm water, rinsing 
both with carbolized or creolinized water, and dresses them 
with pure oil. Of course he should take care to cut the finger 
nails and remove any dirt which may be below the nails. 
After this precaution he may proceed to make an exploration. 
When this examination is made before the cervix is fully 
dilated, he stili finds the calf in its intrauterine position; that 
is, lying on its side which is normal, and which by rotation is 
changed into the abdominal one later. At the end of normal 
parturition the task of the obstetrician has not yet ended. 
The animal, fatigued and exhausted from the act of parturition, 
usually lies quiet for a time. He now takes care that the 
position of the cow be such that the hind-quarters are not 
lying too low. Such a position causes violent after-pains 
which may produce eversion of the uterus. Many breeders, 
therefore, induce the cow to rise as soon as possible. The cow 
should now be rubbed down well to stimulate cutaneous circu- 
lation and to equalize the changed circulatory condition. 

Food at first should be of easy digestion and not too 
plentiful. Warm gruels of linseed, wheat or barley flour and a 
little hay are best. Green food or cold water must not be given. 
(In our country, where cows are generally used to green food, 
no harm will follow its moderate ingestion.—W.) 

Blood and dirt are removed from the udder by soap and 
warm water, and the cow is milked. 

The animal now enters the post-partum period. The 
expulsion of the foetal membranes is yet to occur. Other pre- 
cautions which are to be taken at this stage are fully treated 
under the processes of involution. 


COURSE OF NORMAL BIRTH 77 


THE NEWLY BORN ANIMAL. 


As soon as the calf is born normally, severing of the umbili- 
eal cord takes place without intervention on the part of the 
obstetrician. In bovines, the navel string, being of little 
resistance, tears easily; before the fore-quarters of the calf 
pass the vulva, connection between mother and the young has 
already ceased to exist. 

Although the rupturing of the umbilical cord usually 
gives us little concern, it is nevertheless a very important 
point. 

I shall explain this further and describe how the umbilical 
cord tears and what the consequences. are when the circula- 
tion stops to run through it. 

Rupture of the umbilical cord of the calf differs from that 
of other animals. At birth of the calf the umbilical cord is 
rendered so tense that it ruptures. The umbilical vein tears 
in the umbilicus, while the umbilical artery, after being severed, 
retracts into the subperitoneal tissue. Therefore, this rupture 
in the calf takes place within the abdominal cavity. No hemor- 
rhage follows rupture of the umbilical arteries on account of 
the energetic contractions of the muscularis of the arteries, 
which comprises the whole length of the umbilical arteries. 
After parturition the foetal and membraneous portion of the 
artery is anemic. The peripheral piece of the umbilical vein 
at the site of rupture is cone-pointed and full of blood, while, 
the intra-abdominal portion of the vein often contains a coagu- 
lum (Kehrer). 

After circulation through the umbilical cord ceases, import- 
ant changes occur in the calf: primarily, respiration. It has 
been mentioned previously that by asphyxia of the foetus intra- 
uterine respiration is called forth. Inspiratory movements may 
be provoked in the foetus by compressing the umbilical cord. 

It is a fact that the young animal begins to breathe as soon 
as the cord tears. The thorax expands and the first respiratory 
movement is a slow inspiration, accompanied by rales caused 
by the presence of amniotic fluid in the respiratory tract. The 


78 BOVINE OBSTETRICS 


first respiratory movements are slow and deep, with decided 
movement of the abdominal muscles. A few moments later, 
slimy masses are expectorated and respiration becomes regu- 
lated, so that the respiratory movements become less deep and 
slow, but more frequent. 

Many physiologists have ventilated the question, What 
causes the first respiration? Haller still thought that respira- 
tion depends on the various painful sensations, or probably 
desire for food. Buffon alludes to the stimulus exerted by air 
upon the olfactory nerves and upon the mechanism of respira- 
tion. Others believed that the influence of the cold air induces 
respiratory movements reflectorily. According to Kehrer, 
Blumenbach started the correct investigation of this question. 
He looks upon the cessation of the placental circulation as the 
primary cause of respiration, which explanation has been 
accepted by many. Kehrer thinks that experimental tokology 
should solve the question how far external irritations, as 
temperature of air and other natural processes occurring at 
parturition, are concerned in the production of the first respira- 
tion. For this purpose he experimented with newly born dogs 
still within the amniotic sac, by placing them into water of 
body temperature before the first respiration became manifest. 
The puppies were quiet for one-fourth to three minutes and 
now and then opened and closed the mouth. After this time 
they began to squirm about and raised the head as if to catch 
air. Distinct respiratory thoracic movements were appreciated. 

Whenever the entrance of air was prevented, the animal 
attempted to breathe once or twice per minute, at the same 
time undergoing the above mentioned convulsive movements. 
Any pressure upon the body awoke the animal and instituted 
a strong respiration. After 14 minutes, respiration stopped 
and the heart ceased to beat after 36 minutes. Whenever the 
dogs were removed from the water, after lying in there for a 
few minutes, respiration began at once and the frequency of 
the heart-beats increased. 

From the above Kehrer makes this deduction ; “ The first 
respiration follows the interrupted placental circulation as a 


COURSE OF NORMAL BIRTH 79 


physiological necessity, but that external stimuli (lowered 
temperature, pressure) ordinarily are the first causes of respira= 
tion ; in fact, exert their influence before the disturbed placental 
circulation creates a desire for oxygen by the organism.” 
Increase of carbon dioxide and want of oxygen may irritate the 
respiratory centre, which also may occur by the influence of 
air upon the skin. 

In consequence of the first respiration, many circulatory 
changes take place in the young animal. 

The expansion of the lungs in consequence of the dilata- 
tion of the thorax, the blood of the right heart is strongly 
aspirated into the lungs through the pulmonary artery. Now 
the blood current no longer runs from the right to the left side 
by the oval foramen, but from the right auricle into the right 
ventricle and from here by the pulmonary artery into the lungs, 
and not by Botalli’s duct into the posterior aorta. Botalli’s 
duct closes, and since no blood flows through it, the intima 
folds upon itself and the lumen disappears. According to 
Ellenberger, this lumen is often already closed after four to six 
weeks. Since no blood flows from the pulmonary artery to the 
posterior aorta, blood pressure in the latter is immediately 
lessened after parturition. After the pulmonary circulation 
has been established, blood pressure in the left auricle 
increases; the valve of the oval foramen places itself over the 
opening, and the foramen ovale is closed, this being assisted by 
the flow of the blood toward the right ventricle. After one or 
two years the valve of the oval foramen is united to the septum, 
while it may be completely closed in a six months old calf 
(Franck). 

The increased blood pressure in the left heart causes 
hypertrophy of its walls. 

The umbilical arteries become obliterated and form the 
round ligaments of the bladder. The umbilical vein is com- 
pressed, its lumen disappears, to form later the round ligament 
of the liver. 

The body temperature of the young immediately after birth 
is a little higher than in the mother (Franck). 


80 BOVINE OBSTETRICS 


When the calf is born, the whole skin of the body is 
covered with a dirty, slimy, yellow mass, the vernix caseosa. In 
some calves the color of the mass is intensely yellow. It con- 
sists principally of skin secretions and amniotic fluid. The cow, 
when the calf is placed before her, licks it, and many even turn 
it over with the horns to lick off the vernix caseosa. This 
irritates the skin and stimulates respiration reflexly. It is 
advisable to allow the mother to stimulate the function of the 
skin in this manner. If this is impossible, or where the cow 
refuses it, the calf must be rubbed dry. Soon after birth the 
calf attempts to rise; while meeting with little difficulties at 
first, it finally succeeds, and the animal stands with fore and 
hind legs spread apart trying to sustain equilibrium. 

As a rule shortly after birth, rarely during parturition, the 
first defsecation takes place, when a part of the meconium is 
expelled. The meconium, or fcetal faeces, forms the contents of 
the intestinal tube during intrauterine life. It consists of an 
amniotic fluid which has been swallowed, respectively constitu- 
ents which may happen to be contained in that fluid, as hairs, 
epidermal scales, intestinal epithelium, mucus, coloring matter 
and biliary constituents. In color meconium appears as a 
yellowish, pitch-like mass, filling the whole of the intestinal 
canal. Its color is yellow and its consistency thinner in the 
small intestines. Inspissation of the feces in the colon is 
already a resorptive ante-partum process. The first defecation 
may be caused by the pressure exerted by the diaphragm 
during the first respiration upon the intestinal mass, as well as 
by a collateral hyperzemia following chilling of the skin (Ellen- 
berger). — 

The first milk or colostrum which the calf receives may 
increase peristalsis; being rich in fats and salts, it has some- 
what laxative properties. It is frequently a fact, that ingestion 
of colostrum is followed by intestinal evacuation. It is there- 
fore advisable to give it to the calf. 

Micturition takes place soon after parturition. The fundus 
of the bladder contracts after rupture of the urachus and 
umbilical cord. 


INVOLUTION OF THE UTERUS 81 


Il. 
INVOLUTION OF THE UTERUS. 


After the young has been born, its envelopes are still 
united to the uterine mucous membrane. As soon as the 
uterus contracts after parturition, circulation ceases in the 
envelopes. 

All foetal membranes are termed after-birth, or placenta, 
as their expulsion takes place soon after birth. The stage 
during which they are expelled. might be termed port-partum 
period. Parturition therefore can be divided into the prelim- 
inary, expulsive and post-partum stage. 


I.—EXPULSION OF THE FTAL MEMBRANES. 


The foetal envelopes are still connected with the uterus by 
the foetal placentze. The chorion attaches itself, as previously 
explained, to the maternal placentz, or cotyledons. 

We know that on the surface of the cotyledons the villi of 
the foetal placenta dip between those of the maternal placenta. 
The concave foetal placentze surround the maternal placenta 
like a pot. As long as the circulation exists, the villi of either 
are filled and pressed against each other. The exchange of 
nutritive elements occurs at the bright seam between the 
placental villi, which is formed by the uterine milk, cessation 
of circulation following uterine contractions after parturition 
loosens the union between the villi. Already the circulatory 
changes disturbed the union between the chorion and cotyle- 
dons. : 

The expulsion is effected by contractions of the uterus— 
the so-called after-pains or dolores post-partum. The cotyle- 
dons do not contain any muscular bundles. Therefore the 
conditions for the detachment of a multiple placenta are less 
favorable than for those of a disseminated one. The numerous 
placente of the cow do not separate from the uterus simul- 
taneously, but one after the other. 


82 BOVINE OBSTETRICS 


The feetal placente lying close about the internal opening 
of the cervix become already detached during the labor-pa:ns 
which dilate the cervix uteri, detachments also occur now and 
then during the expulsive stage. Any placente separated by 
the uterine contractions follow, together with the remaining 
foetal envelopes, the direction of the cervical canal, and may 
hang from the vulva. As a rule, shortly after birth of the calf 
a thin cord hangs from the vulva, usually a piece of the 
amnion, of 20 to 30 cm. length. The piece gradually becomes 
longer, more and more foetal membranes appearing after each 
pain. 

The detached chorion, also leaving the vulva, has a char- 
acteristic surface, with flat, round or oval, ragged, reddish- 
brown spot, 4 to 7 or 8 to 12 em. in size. These are the foetal 
placente. The pendulous piece increases in length and thick- 
ness; finally the whole mass drops when the union between 
the last foetal and maternal placenta is severed. 

As soon as the after-birth has been expelled, a limited 
amount of uterine milk, mixed with blood, mucus and foetal 
liquor, which had remained between the envelopes, is dis- 
charged. 

Expulsion of the placenta of the cow takes place four to 
six hours after parturition. It may happen that expulsion 
occurs earlier, or is retarded, or the foetal membranes are 
retained in the uterus. Here they may cause various disturb- 
ances, with which we shall acquaint ourselves later. 

The post-partum or after-pains concerned in the expulsion 
of the placenta are not always of the same intensity. The 
weaker they are the slower the cotyledon becomes anemic 
and the slower is the separation of the foetal from the maternal 
placenta. When the uterus is greatly dilated, as in dropsy of 
the foetal membranes (Hydramnios, Hydrallantois), twins or an 
oversized foetus, the action of the uterine muscle is weak, and 
detachment of the placenta may take a long time. In many 
instances feeble after-pains are assisted by the auxiliary 
abdominal muscles. When this oceurs danger of an inversion 
of the uterus is present. A limited amount of aid by the 


INVOLUTION OF THE UTERUS 83 


abdominal muscles during the immediate post-partum stage is 
physiological. A slanting position of the cow often induces 
violent after-pains. This should be avoided. The care which 
the animal requires in this stage confines itself to see that she 
lies horizontally, that neighboring animals do not step upon, 
tear or devour the placenta. The latter may give rise to serious 
indigestion. This is occasionally seen in cows at pasture. 

The expelled placenta must not remain in the manure 
behind the cow, but should be removed promptly and destroyed 
outside the stable. The udder, tail and hind legs are cleansed 
with soap and water and then rubbed dry. The cow should be 
watched in the interval between parturition and post-partum 
period, in order to care for or render assistance when disturb- 
ances manifest themselves. 


II.—LOCHIA. 


By lochia is understood a uterine discharge continuing for 
several days after expulsion of the foetal membranes. It is 
inconsiderable in the cow and cannot be compared with a 
lochial flow or fluxus lochialis. 

The lochia are a chocolate colored or only faintly colored 
fluid, consisting mainly of uterine milk, and contain also uterine 
epithelium, leucocytes and fat. 

As long as the os uteri remains open the discharge may 
be evacuated, but when the os is closed it may be resorbed 
provided it is aseptic; but it may give rise to serious disturb- 
ances when forming a favorable medium for developing patho- 
genic organisms. 

In the cow this discharge is characterized by agglutina- 
tion of the long hairs on the vulva, by the muco-sanguino- 
lent matter at the inferior commissure, the tail and about the 
vulva. In the first few days after labor the lochia are of dark 
color, to become lighter and finally white and slimy. Physio- 
logically, the excretion of the lochia does not require more 
than eight days. 

It is of less importance in the cow than in carnivora, as 
detachment of the placenta in the latter means injury to the 


84 BOVINE OBSTELRICS 


uterus, since the maternal placenta is also expelled. Never- 
theless, the views as regards the importance of lochia are 
divided. 

Its suppression, some thought, caused in the mare, 
laminitis, articular rheumatism (Deneubourg), also metritis, 
peritonitis and parturient paralysis (Charlier). Later these 
views were not accepted, and but little importance was attached 
to lochia. In fact, they are only an excretion, which, having 
become superfluous after parturition in consequence of the 
process of involution, is removed. 

We know, at the same time, that thé lochia, as far as their 
composition is concerned, are an excellent medium for micro 
organisms. When no exploration is made and parturition runs 
a normal course, the uterine secretion is free from germs. 
Some may be found in the vagina and possibly in the cervix 
uteri. The bacteria are principally streptococci, of limited 
virulence. Whenever these organisms enter the lochia, rapid 
multiplication and increase in virulence occurs, especially when 
bits of decomposing tissue are in the lochia, since putrefactive 
bacteria may make the medium especially adapted for the 
development of streptococci. 

Lochia play an important role in the etiology of puerperal 
septicemia. Schmidt-Mulheim thinks that by chemical 
changes of the lochia, with exclusion of air, a _ oisonous agent 
may be formed, resembling sausage poison, and by its resorp- 
tion into the circulation certain phenomona are produced, to 
which the name of “ parturient paralysis” has been given. 


III. —REGRESSIVE CHANGES OF THE UTERUS. 


After expulsion of the foetal membranes the uterine lumen 
is already materially decreased. The cervix uteri, while con- 
tracted, still permits the passage of the uterus to continue with- 
out being especiaily noticeable; they effect continuously a 
decrease in the size of the organ. Two days after birth the 
cervix is still sufficiently dilated to let two fingers enter the 
uterus, but after four or five days this cannot be done any more. 
It also happens that after expulsion of the after-birth the 


INVOLUTION OF THE UTERUS 85 


uterus contracts but little and slowly. Then the lochia are not 
evacuated, but accumulate in the uterus. This state is termed 
inertia uteri, or uterine sluggishness. Severe hemorrhages, as 
in man, do not happen in this state. Since the cervix uteri 
remains open on account of the wanting uterine contractions, a 
factor quite favorable to the chemical change of the liquid is 
present. 

The weight of the uterus always decreases during the 
process of involution. Baumeister and Rueff state that the 
uterus of a medium sized cow immediately after parturition 
weighs 6 to 7 kg., later 500 to 600 g. All three layers of the 
uterus lose in weight, especially the muscularis and mucosa. 
Let us now consider some points a little closer: First, the 
puerperal involution of the uterine muscle. Since the middle 
of this century examinations in regard to the involution of the 
uterine muscles have been made. Kilian mentions as the 
predominating theory of his time, that the muscular fibres are 
compressed by the after pains, and that the liquid thus squeezed 
out is partly removed by the lochia and partly resorbed. 

According to Kolliker, the process of involution in the 
beginning of gestation depends on hypertrophy and hyperplasia 
of the muscles, but after the fifth month of pregnancy hyper- 
trophy only persists; he says: “ After parturition the fibrillar 
cells of the gravid uterus rapidly decrease in length, at least I 
found them three weeks after delivery only about .03 mm. long, 
and filled with many larger and smaller fat drops arranged in 
rows.” 

Kilian experimented a good deal with rabbits and guinea- 
pigs. He found that all the old fibres perish and become 
replaced by newly formed cells. One might therefore rather 
speak of a regeneration or restitution than involution. 

Heschl agrees with Kilian on the main points, but he thinks 
that the development of fibres only begins in the fourth week 
of the puerperal state. After two months he found the whole 
uterus regenerated. He is further of the opinion that puerperal 
processes, chronic diseases and anomalies in the shape of the 
uterus, have none or but little influence upon its involution, 


86 BOVINE OBSTETRICS 


but certainly upon its reconstruction, namely, in the shape of 
fatty degeneration of the newly formed cells. 

K6lliker states in his microscopical anatomy that the 
muscle cells, which during gestation have become seven to 
eleven times longer and two to five times wider, are reduced to 
their original length three weeks later. As a cause of this he 
mentions atrophy plus fatty infiltration of the contractile 
elements; possibly certain fibres are completely resorbed. 
His observations, confined to man, did not reveal any regener- 
ation, and he can see no reason why this should not hold 
good in the uterus of lower animals. 

Balin closely studied the changes in blood vessels of the 
uterine muscle during the puerperal state. The arteries 
showed cell proliferation of the intima both in the direction of 
the lumen and intima, this process leading to obliteration and 
fatty metamorphosis of the media. The thickening of the 
intima of the larger veins does not result in obliteration, but 
does so in the smaller veins ; these undergo fatty degeneration. 

CG. W. Broers (Holland), from whom the above is taken, 
studied the process of involution on the rabbit and came to the 
following conclusions : 

The decrease in volume of the uterine muscle in the begin- 
ning of the puerperal state depends on the exit of glycogen 
from the hypertrophic muscular fibres, where it was present 
during birth, also on the resorption of the fluid of the cedema- 
tous inter-muscular connective tissue. The glycogen is prob- 
ably carried off by the lymph vessels, after undergoing chemical 
change. The blood vessels lose either entirely or partly the 
blood, while the entrance of glycogen into the muscularis of 
the arteries leads to a decrease of this hypertrophied tissue. 

The entrance of glycogen, during the first hours following 
parturition, is the only cause of the progressive atrophy of the 
muscular elements, but is joined at the end of the first day by 
another process. 

At this time some muscle-cells show droplets of fat. In 
the following days the latter process predominates, the smaller 
and larger drops of fat become confluent, leave the cells and 


INVOLUTION OF THE UTERUS 87 


for some time remain in the intermuscular connective tissue. 
On the fifth day, decrease in the volume of the muscle-cells 
only depends on the emigration of the fat. 

After one and one-half weeks the volume of the muscle 
fibres had decreased until their average size was that of a 
normal uterus. 

The above process never leads to destruction of muscular 
fibres. 

The fat which had formed in the muscular fibres and 
mucosa and deposited in the inter-muscular connective tissue, 
is carried from here by the lymph and vascular channels ; even 
after five weeks some fat is still found. 

The same rotation manifested in the atrophy of the uterine 
muscle also takes place in the arterial muscularis. The lumen 
becomes greatly lessened, due to proliferation of the intima, 
and sometimes becomes obliterated. 

The uterine mucosa after parturition also suffers consider- 
able changes. The cotyledons become smaller, lose their 
peduncular identity and undergo regressive fatty metamor- 
phosis. Fourteen days later cotyledons proper do not exist. 
After three weeks the mucosa has returned to its original state. 
Puerperal processes—for instance, septic metritis—do not influ- 
ence the regressive changes of the cotyledons; that is, they do 
not retard them. 


C.—-ABNORMAL PREGNANCY. 


| fs 
DISEASES AND ACCIDENTS OF PREGNANCY. 


1.—Circulatory Disturbances. 


Already when dealing with pregnancy it was mentioned 
that the total amount of blood in the mother increases during 
development of the young. In consequence of it, an active 
dilatation or eccentric hypertrophy of the left heart takes 
place. This hypertrophy develops so gradually that no dis- 
turbances arise in spite of the greater efforts which the heart 
must make to propel the increased amount of blood over the 
body. The annually occurring pregnancy of the cow, desirable 
from an economic standpoint, conception taking place two or 
three months after the stage of involution, often leads to a 
permanent hypertrophy of the left heart. In old milch cows 
one frequently meets with hypertrophy of the left heart, this 
condition never having caused any disturbances during life. 

In the pregnant animal, swelling of the udder begins at 
the eighth month of gestation. This occurs a little sooner in 
cows which have calved frequently and have been dry for quite 
some time. In primipare the swelling of the udder begins 
four to six weeks before parturition and increases up to birth. 
Many breeders look upon this tumefaction as a favorable 
indication for milk production. The swelling confines itself 
at first mainly to the posterior quarters, but may extend later 
to the anterior half of the udder. 

This swelling before birth is physiological; it may extend 
to the vulva and anteriorly to the umbilicus. 

The tumefaction of the vulva, often so intense that the 


skin becomes glistening and tense, is not caused by a disturbed 
88 


CIRCULATORY DISTURBANCES 89 


return flow of the blood—that is, venous stasis—but is due to 
an active hyperemia. This hyperemia, characterized by its 
redness, swelling, heat and increased sensibility, extends 
beyond the vagina. 

The swelling of the udder and surroundings must be 
attributed to the same causes. But it happens that this 
so-called cedema increases to an extent sufficient to worry the 
owner. The cedema extends at times backwards and up to the 
vulva; the perineal region is swollen, its skin tight, the vulva 
enlarged and the skin of the labiz glistening. 

The udder has reached such dimensions that the skin is 
tense and the teats barely project beyond the swollen udder; 
in other cases the teats are full and milk runs from them. 
All these phenomena only put in their appearance at the end 
of pregnancy, and become fully developed only a few days 
before parturition. 

The swelling may extend along the umbilicus up to the 
fore legs. In primiparz this cedema occasionally becomes so 
prominent, that the inferior abdominal wall hangs down like a 
pillow from the udder to the dewlap. Such an extensive 
tumefaction probably depends also on a disturbed circulation 
—that is, venous stasis. 

The blood of the udder of the cow returns by two 
channels. One part returns through the external mammary 
vein, while the balance flows off through a branch of the 
external pubic vein, which runs upwards from the posterior 
quarter into the obturator and internal pubic vein. 

The venous blood carried off in the above named manner 
therefore has not favorable conditions for its course ; conse- 
quently the slightest disturbance may retard the return flow. 

On account of the swelling of the vulva and the increased 
amount of blood at the vagina, a considerable accumulation of 
blood also takes place in the venous network of the vagina ; 
this venous network also empties into the internal pubic vein. 
In consequence of the stasis experienced by the blood of 
the ascending branch of the external pubic vein, a passive 
hyperzemia takes place in its tributaries. 


90 BOVINE OBSTETRICS 


Only when the swelling reaches such a degree as to 
disturb the general health of the cow, or rising or lying down 
becomes difficult, treatment 1s indicated. As a rule, expectant 
treatment is all that is necessary, the cedema disappearing 
soon after birth. 

The decrease of the swelling of the vulva and vagina in 
the first few days following parturition depends partly on the 
cessation of the reflex hyperemia, partly on the fact that the 
venous blood now flows off more readily by the internal pubic 
vein. 

Prognosis is usually favorable. 

The treatment primarily is directed to equalize the circu- 
lation. For this purpose exercise is to be recommended, 
influencing beneficially the venous circulation. In the winter, 
of course, it is-often difficult to exercise a pregnant cow; but 
then it does not take much room for that purpose. In good 
weather, such an animal ought to get an hour’s exercise twice 
daily. 

When the milk runs out of the teats a few days before 
parturition—quite often the case in heavy milkers—the udder 
ought to be emptied two or three times daily. Many owners 
believe erroneously that the general health of the animal is 
unfavorably influenced by this, while, on the contrary, milking 
is beneficial. It lessens tension and diminishes fatigue the 
result of a long continued standing posture ; as a consequence, 
the cow can lie down. 

Since this treatment is almost invariably sufficient, thera- 
peutics may confine itself to it. Of course it is understood 
that rational feeding during pregnancy is the best means to 
prevent enormous swelling, as seen in animals of a lymphatic 
disposition. 

I again emphasize, that swelling of the udder, vulva and 
its neighborhood is physiological, and that only extraordinary 
swellings, influencing unfavorably the other functions of the 
animal, are pathological and demand treatment. 

It has been recommended to treat this cedematous condi- 
tion by massage and stimulating embrocations, as spirits of 


INVERSION OF THE VAGINA DURING PREGNANCY 91 


camphor, ammoniacal liniments, ete. Although this is not 
detrimental—in fact, may slightly stimulate circulation—this 
treatment may be safely omitted, unless it serves to treat the 
owner rather than the patient. 

[While liniments may be of doubtful value, the following 
composition, applied three to four times the first day and once 
the second day, has always given me excellent results: Ol. 
terebinthine, 90; spts. camphore, 120; aque, 240; shake.—W. | 

Scarifications are not advisable, as they may lead to infec- 
tion, especially when animals lie upon earth floors—only too 
often the case. Here pathogenic organisms may exert their 
detrimental influence when the proper occasion offers itself. 

Formerly, when this condition was wrongly interpreted as 
a hydremic state, the internal administration of diuretics was 
employed ; their use may be safely omitted, as it is apt to pro- 
duce injury. Advanced pregnancy anyway contra-indicates 
their administration. Therapeutics is therefore better confined 
to advise against certain methods of treatment than to actively 
interfere. Experience teaches that but little medication is 
required in these cases. 


2.—Inversion of the Vagina During Pregnancy. 


Definition.—Prolapsus of the vagina consists of an inver- 
sion of the superior and lateral vaginal walls, so that the 
mucosa is visible between the labiz or even the whole 
inverted vagina hangs from the vulva. When the inverted 
vagina does not extend beyond the vulva, it is termed inversion 
of the vagina (inversio vagine). When it has passed beyond 
the lips of the vulva, it is called inversion and prolapsus of the 
vagina (inversio et prolapsus vagine). An inversion which 
repeats itself during pregnancy is known as habitual prolapsus 
vagine. 

Topographical Anatomy.—The vagina lies between the 
rectum and bladder. It is fixed by the perineal muscles, the 
deep perineal fascia, further urethra, vesico-vaginal and recto- 
vaginal excavation. 


92 BOVINE OBSTETRICS 


Anteriorly it is held by the vaginal portion of the 
uterus and is there held in position by the cervix uteri. 
The superior wall consists of mucosa, muscularis and, partly, 
adventitia. At the abdominal cavity the adventitia is replaced 
by a serous membrane—that is, the peritoneum as part of the 
recto-vaginal excavation. The inferior wall, up to the angle 
formed by it and the urethra, is also covered by a serous layer. 
The urethra in the cow is held in place by the very strong 
pubo-vesical ligament, composed of strong elastic fibrous 
fibres. This ligament also indirectly fixes the inferior vaginal 
wall. The upper and lateral walls of the vagina, therefore, are 
more easily displaced than the lower one. 

Astiology.—The causes inducing this inversion are partly 
predisposing, partly direct. As an occasional cause, we must 
mention relaxation of those organs which fix the vagina, as the 
deep perineal fascia, perineal muscles, the broad pelvic liga- 
ments and mesometrium. This relaxation occurs frequently at 
the end of gestation, when the pelvic tissues become infiltrated 
in consequence of increased blood pressure. Predisposed 
cows are lymphatic animals which gave a great deal of milk 
while pregnant, and emaciated ones. Experience teaches that 
cows advanced in gestation easily get a prolapsus, when sub- 
jected to long drives and railroad travel. Prolapsus vaginee 1s 
also caused by standing cows on floors inclined too much to the 
rear. It is generally known that when the posterior extremi- 
ties of the animal during gestation are kept lower behind than 
in front, inversion of the vagina often occurs. The continuous 
pressure exerted upon the superior wall of the vagina, the 
abdominal viscera in such a position forces it to turn its con- 
cave side toward the abdominal cavity. The gravid uterus 
also presses upon the superior vaginal walls, pushing this one 
backwards. The greater this pressure, especially toward the 
end of gestation, the more is the vagina displaced toward the 
vulva. This factor already belongs to the domain of direct 
causes. When the intestines enter the recto-vaginal excava- 
tion,—always the case in this sloping position of the hind- 
quarters,—the uterus also becomes displaced. The weight sf 


INVERSION OF THE VAGINA DURING PREGNANCY 93 


the intestines widens this originally small excavation. Asa 
consequence, the superior and lateral walls of the vagina are 
forced downward and backward, thus lessening the lumen of 
the vagina. The continuous pressure displaces the vaginal 
walls more and more, until it reaches the vulva or extends 
beyond it. When limited inversion confines itself to the upper 
wall, when more extensive to the upper and laterai walls, and 
when complete, it also includes the floor of the vagina lying in 
front of the meatus urinarius, the vaginal portion of the uterus 
then becoming visible between the labiz. 

Symptoms.—Prolapsus vaginze is mostly seen in cows 
which have already calved several times; it is frequently seen 
in old cows, but also cows which only calved once may show an 
inverted vagina toward the end of the second pregnancy. It 
is occasionally noticed in heifers, where a previous dystokia 
led to considerable destruction of the vagina and its sur- 
roundings. 

The owner usually notices this affection when the inversion 
is already quite considerable. More limited degrees, where 
the superior wall is pushed backward and into the lumen of 
the vagina, and which is not visible from without, escape his 
observation. As the prolapsus progresses, the inverted parts 
appear as a rose-colored tumor, separating the labize and only 
noticeable when the animal is in the recumbent position. 

When the cow rises, the tumor mostly disappears, as the 
abdominal pressure ceases and the upper, respectively, lateral, 
walls of the vagina return to their original position. 

In cases of complete inversion and where the cow lies 
very low behind, the prolapsus vagina extends beyond the 
vulva. The tumor, which is now visible outside the vagina, is 
as large as the head of a child or man; its surface is formed 
by the mucosa of the vagina. <A prolapsus of head size may 
disappear when the cow gets up, but appears as soon as she 
lies down. A large prolapsus, and especially when the inverted 
portion is eyposed some time to the air, and the mucosa 
inflamed, spontaneous reposition does not take place when the 
the cow rises. 


94 BOVINE OBSTETRICS 


In such cases the services of the veterinarian are mostly 
wanted. On his arrival the inversion is often already several 
days old, the mucosa swollen, at times torn and soiled by fecal 
matter. The animal at the same time shows but little disturb- 
ance of its general health; for this reason the owner waited so 
long before he called the veterinarian. 

The patient feeds well, ruminates; pulse, respiration and 
temperature are normal; but in receiving the history one is 
informed that she defecates often, a little at a time, and that 
micturition is difficult. The animal strains a good deal, accom- 
panied by the passage of small amounts of urine. The latter is 
easily explained. The pressure exerted by the inverted vagina 
upon the urethra interfers with the flow of urine. When such 
a patient is examined by gliding the hand around the inverted 
part, one notices that the hand cannot advance beyond the 
upper commissure of the vulva, while it enters the inferior 
commissure and may advance as far as the urethral opening. 
Such an exploration usually causes the animal to strain. 

Differential Diagnosis.—When the symptoms given so far 
are carefully considered, this trouble is not easily mistaken for 
other disturbances. Nevertheless, it is possible to mistake 
prolapsus vagine for tumors of the vagina, retention cyst of 
the vulvo-vaginal glands (glands of Bartholine), with inversion 
of the urinary bladder. 

Tumors are recognized by their greater consistency and 
base, which can be felt. The retention cyst of the vulvo-vaginal 
gland, which fluctuates, lies laterally on the floor of the vesti- 
bule. Prolapsus of the urinary bladder (inversio vesicze) is 
characterized by the regular dropping of urine, the finger 
cannot detect the meatus urinarius, and the superior and 
lateral walls of the vagina are in place. The diagnosis there- 
fore is not difficult. 

Prognosis.—Prolapsus in the cow is not dangerous in itself, 
provided it is properly treated. Even when the owner neglects 
a complete inversion, quite some time must pass before the 
animal is seriously influenced. Cases are known where a pro- 
lapsus as large as a head, hanging from the vulva for three 


INVERSION OF THE VAGINA DURING PREGNANCY 95 


weeks, with necrosis of the whole mucosa, did not produce any 
constitutional derangement. 

A cow suffering with prolapsus vaginz for three weeks was 
to be slaughtered. She was not only perfectly well, but the 
owner also stated that her general condition within the last few 
weeks had not suffered any. His anxiety was not caused by the 
prolapsus itself, but by the morbid changes taking place in the 
inverted portion; as a result of necrosis, it had become black. 
After slaughter the cow proved to be with calf since six months. 
This shows how well a cow may endure such an inversion. 

With regard to a complete recovery, prognosis is not 
always favorable. When the prolapsus disappears immediately 
after parturition, many think that complete recovery has taken 
place. As soon as direct causes present themselves again—for 
instance, pressure from distended intestines, well advanced 
pregnancy—inversion puts in its appearance. It is understood 
that a predisposing factor, as mentioned in the discussion of 
the etiology, is present. At the same time, we must admit that 
by proper food and nursing a good deal can be done toward 
prevention in the future. 

Therapeutics.—The presence of a prolapsus vagina, which 
does not disappear spontaneously when the cow rises, calls for 
its reposition. Previously it must be cleansed thoroughly. 
The dirt, usually feces, is washed off with clean water; the 
labie, tail and thighs are cleansed with soap and warm water. 
While doing this, the animal is standing. Now the inverted’ 
vagina is treated with antiseptic agents, as 2 to 3 per cent. 
solution of creolin, 2 per cent. solution of carbolic acid or alum. 
The latter is to be recommended as a cheap and efficient 
astringent. Reposition is next practiced. One usually succeeds 
by pressing in an upward and forward direction with the 
whole hand upon the inverted parts. Should it not suffice, it 
is well to change the position of the animal by raising the hind- 
legs higher than the fore-legs and thus removing the pressure 
exerted upon the pelvic organs by the abdominal viscera. The 
prolapsus is now pushed forward by placing one hand on each 
side of it. It might be well to cover, the hands with a clean 


96 BOVINE OBSTELRICS 


cloth in order to avoid injury to the parts. The pressure, 
which must be gentle, even and continuous, must be exerted 
with the whole hand. In this manner the vaginal walls can 
usually be replaced. 

Following reposition, the hand is introduced into the 
vagina; wherever necessary, folds are smoothed and the 
anterior position of the inferior wall is slowly and gently 
replaced. An extensive inversion, especially when exposed to 
the air for some time, cannot always be reduced in this manner. 
Here another method is employed. The animal is prepared as 
before, but the prolapsed portion should be bathed with a 2 
per cent. alum solution for ten to fifteen minutes. Now a 
bandage, 20 em. wide and 1.5 m. long, moistened with the alum 
solution, is slowly and tightly wound around the inverted 
vagina. Reduction of the prolapsus is effected by pushing in 
an upward and forward direction with both hands. 

Continuous straining makes reposition very diflicult. 
Internal medication is not required, as it may be limited by 
simple means. Already elevation of the hindquarters dim- 
inishes straining; it is decreased still more by pinching the 
back of the patient while reducing the parts. Walking the 
animal slowly and reducing the prolapsus at the same time, if 
possible, often gives good results. (Very bad cases can usually 
be managed nicely after giving them chloral hydrate, 60 ; tinct. 
opii., 30.— W.) 

In order to prevent excessive straining after reposition of 
the prolapsus, gentle exercise is useful. 

It does not suffice to reduce the inversion; its eventual 
recurrence must also be prevented. 

A displacement of the vaginal walls only could be pre- 
vented by introducing a pessary, by a rubber pouch or pig’s 
bladder distended with air and held in place by suturing the 
lips of the vulva. Theoretically, this is very nice, but practice 
teaches that the application of such means is useless, as the 
patients strain violently after the introduction of the pessary, 
this making the cure worse than the evil. Therefore, this 
method is best left alone, and other means quite efficient in 


INVERSION OF THE VAGINA DURING PREGNANCY 97 


practice are to be employed to prevent recurrence of the inver- 
sion. The following methods are indicated : 

The bandages, fully discussed at prolapsus uteri, are of 
little use here, as they can only be employed temporarily. The 
simplest operation consists of suturing the lips of the vulva 
(labial suture). It may be done with tape, 1 to 1} cm. wide. 
The first stitch is put in directly below the superior commissure 
of the vulva, the second one half way down the labie. When 
three sutures are put in, the second and third suture are placed 
at an equal distance between the first suture and lower commis- 
sure, so that the space be- 
tween the upper stitch and 
inferior angle of the vulva 
is divided into three equal 
parts by the two lower 
stitches. In order to pre- 
vent tearing, the stitches 
are placed 3 to 4cm. from 
the lips and run through 
the skin, subcutis, muscu- 
laris, submucosa and mu- 
cosa. In the other lip the 
stitches perforate horizon- 
tally the same layers, only 
in an opposite direction. 
It is important to place 
the first stitch sufficiently 
high to prevent prolapsus 
of the upper wall of the vagina. Two sutures are mostly sufii- 
cient. Since these stitches usually have to remain until par- 
turition, ordinary tape does not suffice, as it may tear, leather 
strings having the same disadvantage. The so-called labial 
gate is certainly the best agent. It consists of two or three 
heated copper needles, 12 to 14 em. long, each with an eye and 
point. After the needles have been pushed through both lips, 
the point is broken off by filing a little groove at the point of 
fracture. Then an eye similar to the one on the other side 





Fig. 14,—The Gate, labial suture. 


98 BOVINE OBSTETRICS 


is made there with a forceps. Two such needles suffice. 
To prevent tearing, it might be well to place a leather 
washer between the skin and eye of the needle. The suture 
stays well, does not tear out and discommodes the animal but 
little. The above drawing (Fig. 14) explains such a suture. 

Deneubourg’s method consists of perforating the labize 
with two thin sticks. Each stick has a cross-piece firmly united 
to it on one end, a detachable sharp point being on the other 
end. After perforating both labixw, the sharp point is unscrewed 
and a cross-piece of the same shape as those on the other end 
is fastened by means of a screw. 










































































Fig. 15.—Sauberg’s Labial Ring. 


The application of this instrument is easy and simple, but 
the copper suture is cheaper and can be readily procured. 
Sauberg constructed a ring, termed ‘“ Sauberg’s Vaginal Ring.” 
It is 8 mm. wide and 2 mm. thick, 17 cm. long, and made of 
copper. Its blunt part shows near its end a little hook 4 mm, 
long; the other and pointed extremity has a little hole of 2 mm, 
diameter, 2 cm. from its sharp point. Before its introduction 
the ring is spread out. Now the labiw are perforated at a 
proper distance from the free border, both ends of the ring 
are bent toward each other, and the hook is pressed into the 
little hole and may be flattened with a pair of pincers, practi- 
cally riveting the two ends. 


INVERSION OF THE VAGINA DURING PREGNANCY 99 


Van Leeuwen (Holland) describes a modification for 
the “labial ringing”: “I first hobble the animal’s hind legs 
and place an assistant on each side of the cow to prevent her 
from moving about. Now I perforate both labiz of the vulva 
with an ordinary seton needle and pull a piece of rubber tubing 
through the holes. The latter is done by attaching the gutta- 
percha tube to the seton needle and thus pulling it through the 
wounds, or by grasping the tubing with an artery forceps 
pushed through the wound. After the tube has perforated 
both labiz, a figure 8 knot, close to the vulva but still allow- 
ing a little vantage, is made. To further secure both knots 
they may be tied by string. 

Two such sutures, requiring about 1 m. guttapercha tubing, 
are sufficient. The great advantage of this method lies in the 
point that such a suture may remain for months, even years, 
without tearing out, due to the softness and elasticity of its 
material. 

Wollenmann, at Eschenbach, constructed an apparatus 
consisting of a sharp needle, at the blunt end of which a little 
hook is found. The needle is passed through the labiz ; into 
the hook at its blunt end he hangs a brass ribbon which has an 
eye at the one end and a little hook at the opposite end. The 
brass ribbon is pulled through the lips by means of the needle, 
and by bending its two ends toward each other it is fastened by 
putting the little hook into the eye. 

Should we see during reposition that the vaginal mucous 
membrane is injured or shows superficial necrosis, on account 
of prolonged exposure to the air, treatment is imperative. For 
this purpose the vagina is irrigated twice daily for three to five 
minutes with a warm 2 per cent. alum solution. The solution 
must not be cold, as it may induce the animal to strain. 


3.—Paralysis of Gestation, Paraplegia ante Partum. 


This name comprises many disturbances and derangements 
of the most varied kind, so that we cannot speak of a definite 
clinical entity. It is given this name, as the closest examina- 
tion does not result in an exact diagnosis. 


100 BOVINE OBSTETRICS 


Definition.—This disease occurs occasionally in cows which 
have calved repeatedly, more rarely in heifers, several days or 
weeks before parturition, and is characterized by a more or less 
complete paralysis of the hindquarters, so that the animal is 
unable to rise. 

Atiotogy.—The following disturbances and diseases, in 
which the cow cannot rise, must be distinguished from para- 
plegia ante partum. 

1. Cows well advanced in pregnancy become cast by lying 
too close to the feeding trough or partition. Such animals 
make vain attempts, since they cannot extend head and neck 
sufficiently to get upon the knees. We must think of it while 
conducting an examination and pull the patient back in order 
to furnish her more favorable conditions. It also happens 
that the cow is so utterly exhausted after making persistent and 
fruitless efforts to rise, that a few hours of rest are necessary 
before she will get up. | 

2. Great debility of a pregnant cow. This may be caused 
by gestation, hydrallantois, ascites, but also from insufficient 
nutriment. It can hardly be difficult to recognize such states ; 
at the same time I refer to the different chapters dealing with 
those subjects. 

3. Fractures, luxations and contusions may occur in preg- 
nant animals and make it impossible for them to rise. A 
thorough examination, where we must not omit to roll the 
patient over in order to inspect all parts, may establish the 
presence of such lesions. 

4. Osteomalacia. Cows with osteomalacia, which has 
become worse during pregnancy, may remain down before 
birth, without suffering with fractures (St. Cyr and Violet). 
The course of the disease, the knowledge of the etiological 
moments and their effects upon other animals of the same 
stable, will throw light wpon the case. But there are patients 
not suffering with any of the above named disturbances or dis- 
euses, and yet paraplegia ante partum is present. The disease 
only oceurs a few days before parturition and is caused by an 
infiltration of the lumbar and pelvic muscles. Although this infil- 


PARALYSIS OF GESTATION 101 


tration per se does not entirely explain this paralysis, other 
auxiliary causes, as voluminous but little nutritious food, 
assists in rendering it difficult or even impossible for the cow to 
rise. 

Symptoms.—The disease sets in two to five days, at times 
earlier, even fourteen days, before parturition. These cases 
oceurring several weeks before birth depend probably on other 
causes. At times certain premonitory symptoms, as weakness 
of the posterior extremities, paddling, precede paraplegia ; in 
other cases the patient goes down without previously showing 
any symptoms suggestive of paralysis. The general state of 
health is good, the cow eats well, ruminates, defeecation and 
micturition are normal, she lies in a normal position with the 
head erect, and cheerful expression of the eye; in short, all 
that is wrong is her inability to rise. 

When we attempt to make her get up, she may weight the 
knees and rise sufficiently behind to rest on the fetlocks, but 
that is her limit. External examination, as well as rectal 
exploration, does not detect any abnormality. Sensibility of 
the hind legs is also normal. The animal can move the hind 
legs, elevate and extend them, may even roll over from one side 
to the other. In the latter instance we may expect her to get 
up soon by herself. 

Course-—Experience teaches that the patients mostly 
remain in the recumbent position until parturition. When it 
occurs without extraordinary efforts on the part of the animal, 
or especial disturbances during extraction, the animal mostly 
rises soon afterward on the same day or on the following. At 
first some weakness behind persists, but this disappears soon. 

When, however, the cow becomes paralyzed ten to fourteen 
days before parturition, decubitus and its sequels—even a fatal 
termination—soon set in, unless she is nursed most carefully. 
With proper care such patients do well up to parturition and 
rise soon afterwards. It is quite natural that recovery ensues 
as soon as the infiltration of. the pelvic muscles and the dis- 
turbed circulation after evacuation of the uterus cease, and the 
maternal organs again are properly nourished. Paraplegia 


102 BOVINE OBSTETRICS 


ante partum may terminate fatally when of long standing, as a 
case reported by Vermast teaches. Vermast (Holland) examined 
a cow which went down twenty-two days before parturition, 
without showing any other phenomena. The owner thought 
she had “ wolf in the tail,” that is, a softening of two or three 
last coccygeal vertebrae, a condition which is seen almost in 
every cow well advanced in pregnancy, and of course cannot be 
the cause of paraplegia. After the calf was delivered, her con- 
dition became worse and worse, so that she had to be killed 
finally. Post-mortem examination revealed the following : 
Abseesses in the right lung; the quadratus lamborum, ilio psoas 
and psoas parvus were very pale and showed serous infiltration; 
serum had accumulated between the dura mater spinalis and 
arachnoidea; the spinal cord of the lumbar region was some- 
what softened and the gluteal muscles atrophied. 
Therapeutics.—The treatment of such patients will be 
mainly a dietetic one. They are given food which is not volum- 
inous but easily digested and nutritious. They should receive 
a horizontal, thick straw bed, the hindquarters must not be 
lower than the fore legs, as otherwise prolapsus vagine might 
appear. To prevent bed sores, the cow must be turned over 
twice daily. In order to do this, the legs are flexed against the 
body of the cow, three men are stationed on the opposite side 
against her withers, back and loins, to roll her over her legs. 
It is strictly to be avoided to roll her over her back. Many 
owners are not satisfied with such advice alone; they demand 
medications. The latter is not necessary, but when it con- 
tributes to ease the owner and obliges him to execute the other 
suggestions, it is well to prescribe, for instance, a liniment to 
be applied several times daily to back and spine, rubbing of 
the legs with spirits of camphor, and massage with a straw 
wisp may influence the circulation favorably. Sometimes the 
question is raised whether such a patient should not be placed 
upon her legs. 
When the efforts of the cow indicate that she can rise with 
some assistance, two or three men properly placed and directed 
may assist her to do so. To raise a cow with pulleys, or to 


PARALYSIS OF GESTATION 103 


place her in slings with the whole weight resting upon the 
belly-band, is ruinous. A cow when once up must stand upon 
_her own legs, but may of course be slightly supported. 

In order to assist a cow to rise, Von Johne’s method is 
practicable. A strong and long rope is placed upon the ground 
and all around the cow, so that it lies in front under the sternum 
and behind under the ischial tuberosities. The rope is tight- 
ened and its ends tied together. At each side of the cow three 
persons are placed, who grasp the rope with the hands and 
raise the cow when the word is given. The rope does not slip, 
as it rests against the sternum and ischial tuberosities. When 
necessary, both sides of the rope may be united by cross ropes 
_ behind the elbow under the breast. Experience teaches us 
that when a paralyzed patient is carried to the pasture (pro- 
vided the weather permits and grass is plentiful), the danger 
of decubitus is much less and the attempts at rising by the 
animal and assisted by the owner are much more successful. 

It is advisable to put the cow upon her legs in the above 
manver, soon after parturition. 

[In the treatment of ante-partum paralysis, artificial abor- 
_tion is the most successful therapeutic agent. My colleague, 
Dr. T. F. Moyle, of Waterford, and myself tried it too many 
times to leave any doubt. Observe the following rule: When 
the cow is still able to rise and wabble, open the os uteri— 
(take your time)—and with any instrument (we use the repeller) 
perforate the foetal membranes, and leave her alone. When 
the cow is down and unable to rise, open the os uteri, enter the 
foetal membranes and extract the foetus. We never failed to 
see the cow rise and do well within twenty-four hours after the 
removal of the young.—W. | 

I shall briefly consider the complications of this ailment. 
First, prolapsus vagine, which may become very troublesome. 
When left to itself, it becomes eventually so great that the vagi- 
nal portion of the uterus appears between the labizw. Attempts 
.to reduce it are only then successful, where the hindquarters 
jare elevated above the foreparts ; only then is suturing of the 
vulva possible, as otherwise the stitches tear out in a few days. 


104 BOVINE OBSTETRICS 


Although inversion is a serious complication, one must 
not despair too soon. When reposition is successful and lasts 
unti! parturition, everything usually ends well, but care must 
be taken that the posterior extremities are kept in an elevated 
condition during parturition. 

Digestive disturbances are often seen in such patients. 
Its characteristic symptoms are: Appetite is lessened, rnmina- 
tion ceases, defecation indolent. Feces are hard and are 
passed in balls. Tympanites may be present. Here dietetic 
treatment is the main thing. Nutritious, easily digested 
and not voluminous food is required. Hydrochloric acid, 
and, when necessary, a saline purge, should be administered. 
Quickly arising tympanites is corrected by puncturing the 
rumen. When cows, advanced in pregnancy, rest upon the 
left side for some time, the functions of the rumen are interfered 
with by the pressure from the gravid uterus. Belehing is pre- 
vented and tympanites follows. The treatment consists of 
rolling the animal upon the right side or by placing her upon 
the knees and flexed hocks in a straight position. Eructation 
immediately follows and tympanites subsides. This exceed- 
ingly simple and rational method is used with much success by 
many practitioners. When discussing embryotomy and pro- 
lapsus uteri, I shall take up tympanites, following improper 
positions. 


4.—Hernia of the Uterus, Hysterocele. 


When, in ventral hernia, the gravid uterus with the foetus 
forms the contents of the hernia, it is spoken of as /hysterocele, 
or hernia uteri. It is hardly reasonable that the uterus would 
pass through a hernial orifice in the unimpregnated state ; the 
manner in which the mesometrium holds the body and horns 
of the uterus in place, makes this almost impossible. But 
when the uterus is gravid and a part of the impregnated 
cornu extends beyond the anterior border of the mesometrium, 
the pregnant uterus may pass through a rent in the abdominal 
walls and form the contents of a hernial sae. 


HERNIA OF THE UTERUS 105 


Should rupture of the abdominal muscles be of recent 
date, the hernia enlarges as soon as the pregnant uterus 
sinks through the orifice. It sometimes happens in pregnant 
cows, that solution of continuity of the abdominal muscles 
only occurs toward the end of gestation, as a result of the 
great weight and enormous distention of the abdominal 
muscles ; then a large rupture appears, containing the gravid 
uterus. 

Many such cases have been published. YV. Lindenberg 
reports one due to an hydrallantois. The cause was the 
extraordinary distention of the abdomen. The cow could rise 
with difficulty, as the belly, which before its rupture was so 
greatly distended that the cow could barely stand in the stall, 
now almost touched the ground. The udder was pushed for- 
ward to the middle of the belly. Post mortem examination of 
the cow showed that the pubic insertion of the rectus abdominis 
had been torn off. 

Some years ago I examined a cow which suddenly showed 
a large ventral hernia. I found that the rectus abdominis had 
torn loose from the pelvis. The teats were only 20 cm. from 
the ground. About eight days later the cow calved, and by 
means of powerful extraction twins were born. Although 
manual removal of the afterbirth became necessary, which was 
only partly possible, parturition ran a normal course. The 
extent of the rupture remained ; a few days later the cow was 
slaughtered. 

Ai tiology.—Anything causing an excessive distention of the 
abdominal walls is a predisposing factor of hernia. As such 
we may mention: Hydrallantois and multiple pregnancy. A 
serous infiltration on the abdominal muscles may also predis- 
pose rupture of muscular and tendinous fibres. Rupture of 
the rectus abdominis is usually the result of traumatism, when 
the above mentioned states exert their detrimental influences. 

Symptoms.—The hernia may occur in various places. The 
abdominal muscles usually tear in the linea alba, near the pubis, 
or in the right lower abdominal region. Then the hernial sac 
and contents are visible. 


106 BOVINE OBSTETRICS 


Palpation at times reveals parts of the foetus. When the 
rupture occurs in the right lower abdominal region—thai is, 
alongside the linea alba—the udder may remain in situ, and to 
the right of it a hernia of enormous dimensions (Fricker). 
When the right abdominal muscle tears off the pelvis, the belly 
and udder descend until the teats of the latter almost touch 
the ground. 

Prognosis.—Prognosis with regard to hernia uteri is always 
unfavorable. When originating during pregnancy, danger arises 
that it enlarges as the foetus develops. The fact that it may 





Fig. 16,—Uterine Hernia (Fricker). 


become incarcerated and parturition difficult justly entitles us 
to make an unfavorable diagnosis. 

Therapeutics.—There is practically no treatment when an 
extensive hernia appears toward the end of pregnancy. The 
owner rather waits for parturition, provided it is to be expected 
shortly, and then slaughters the cow. In this way he may get 
a living calf. Only when tke hernia interferes with parturition, 
can we think of rendering assistance. As the result of the dis- 
placement, the normal direction of the uterus is changed, a 
deviation commonly termed inferior obliquity or anteversio. 
Obstetrical therapeutics will be fully discussed under that head; 
I shall allude to it here only briefly. Labor pains in this con- 


ABORTION 107 


dition are only weak. The expulsive force is greatly diminished 
since now the auxiliary muscles are in abeyance, and therefore 
forcible extraction is called for. Besides that, reposition is 
made difficult, as certain parts of the foetus, on account of the 
great distance, are not accessible to the hand. Under these 
circumstances it is best to raise the belly of the cow with a 
covered board, or to put her into a dorsal position, to reach the 
foetus. The strongly dilated uterus frequently contracts but 
slowly after extraction, and as a consequence the foetal enve- 
lopes are retained. This must be considered and the treatment 
shaped accordingly. After parturition, intestines often enter 
the hernial sac, so that the hernia persists. When the right 
rectus abdominis is torn off, uo recovery is possible. — 


5.—Abortion. 


Definition.—The period of gestation of the cow is pretty 
well established. It is, on an average, 40 weeks. Expulsion 
of the foetus at that time is spoken of as natural parturition, or 
partus maturus. Expulsion before this time, provided the 
foetus is capable of living, is termed premature birth, or partus 
prematurus. When expelled at a time when insufficiently 
developed to live external to its mother, it is known as abortion, 
or partus immaturus. 

Abortion therefore means expulsion of the young at an 
earlier period than premature birth; the latter can only occur 
in the cow after the thirty-second week of her period of gesta- 
tion. As a rule, the word abortion is used to indicate a 
premature expulsion‘of the foetus, whether able to live outside 
the uterus or not. 

In the further course of my discussion, [ mean by abortion, 
premature expulsion of the foetus, no matter at what time it 
occurs. 

None of our domestic animals are so frequently affected 
with this disease as the cow. The economic importance of this 
disease is great, especially when of an enzootic nature ; but also 
when attacking the only cow of a smaller breeder the damage 


108 BOVINE OBSTETRICS 


to that party is considerable. As a result of abortion, the foetus 
is born either dead or reaches the external world in a worthless 
state; further, the production of milk is interfered with, and 
the total sum of milk of the coming period of lactation remains 
far below the normal quantity. The cow herself may also 
become diseased. Chronic and acute sequels often follow 
abortion, as retention of the afterbirth (retentio secundinarum), 
and, in consequence of it, emaciation, metritis, leacorrhcea and 
even a fatal pyzemia. 

Abortion may confine itself to single cases here and there 
in one or more stables or herds. Among twenty or thirty cows, 
one or three to four cases appear. Under these circumstances, 
we speak of a sporadic abortion. When numerous cases mani- 
fest themselves so frequently in a stable or certain herd or 
locality, that natural parturition forms the exception and abor- 
tion the rule, one speaks of a stationary abortion, Stationary 
abortion in stables, herds or localities, when depending on an 
infection, is termed infectious abortion ; when of an enzootic type, 
it is called enzootic abortion. As the definition shows, stationary 
abortion is not necessarily infectious. The causes of abortion 
may be the same for all animals—for instance, mouldy food. 
Just as little need an infectious abortion be stationary. It may 
confine itself to one or more stables; the latter is often 
observed. 





I.—NON-INFECTIOUS ABORTION. 


Av iology.—Let us first raise the question, Why is abortion 
so common in the cow and rare in the balance of domestic 
animals ? According to Schneidemuhl, one of the most import- 
ant causes of extensive abortion among milch cows lies with- 
out doubt in the faulty selection and care of the mother, being 
contrary to all laws of hygiene and rational breeding. As a 
matter of economic interest, the cow has been pushed to her 
physiological limits; a step further, and the great lacteal secre- 
tion induces disturbances, which leads to the question whether 
the greater gain in milk overbalances the acquired want of 
resistance, predisposing her to many diseases. 


ABORTION 109 


Early conception, often at an age of fourteen to fifteen 
months, in consequence of which the heifer bears a calf when 
two years old, aceustoms the generative organs to an early 
function. The cow calves every year, and is expected to give 
plenty of milk even in a well-advanced stage of pregnancy. 
Even by feeding her heavily before the first parturition one 
attempts to increase future lactation. 

Stockfleth is right when he says that in the cow keen 
competition exists between the uterus and the mammary glands, 
each doing their utmost to appropriate a part of the nutriment 
destined to develop the foetus and milk production. The 
weaker one succumbs, and if it be the uterus, abortion takes 
place. 

The conditions enumerated above usually do not suffice to 
produce abortion. They can only be termed predisposing 
causes. Often insignificant causes, in themselves unable to 
produce abortion, do so when the above named conditions 
exist. The effects of all causes, infectious and non-infectious, 
to be mentioned separately, are much more powerful when the 
animal is predisposed. Direct causes are: 

1. Disturbances of the circulation, influencing the circulatory 
territory of the gravid uterus. Circulatory disturbances may 
create labor pains. During ordinary parturition, the reflex 
hyperemia from the ovaries produces uterine contractions 
(Franck). 

Tn that time when abortion takes place the uterus is much 
less sensitive than toward the end of the period of gestation. 
Venesection changes blood pressure when a good deal of blood 
is abstracted, and may produce abortion. For this reason, 
phlebotomy is not to be practiced on the pregnant animal. 
Psychic influences may effect a reflectory narrowing of the 
blood vessels, and thus somewhere else a collateral hy perzmia. 
Several instances are known where a cow suddenly frightened 
aborted. 

Retarded venous circulation, as by pressure upon the 
posterior vena cava, the blood flowing through the uterus con- 
tains much carbon dioxide. The foetus itself is unfavorably 


110 BOVINE OBSTETRICS 


influenced, becomes asphyxiated, and may die. The cause has 
had a two-fold action ; on the one side, uterine contractions are 
produced ; on the other, death of the foetus by blood surcharged 
with carbon. 

There are many disturbances which may follow when the 
blood is laden with carbon dioxide, as tympanites, chronic 
indigestion, pneumonia and many others. They may produce 
abortion. It is an old fact that certain food, liable to produce 
indigestion and other disturbances, may cause abortion ; for 
instance, great quantities of hot distillery slops, frozen turnips, 
clover. They act indirectly by causing circulatory disturb- 
ances, or directly (see 2). 

2. The presence of certain materials in the blood, irritating the 
uterine nervous system, and in this manner possibly producing 
contractions. The detrimental influence of various food stuffs 
and many causes belong here. 

(a) Mouldy food. Many fungi living upon the most com- 
mon plants are accused of producing abortion. It is astonish- 
ing how well a cow stands mouldy hay. We often see the 
owner feed his cows hay which is full of dust, without bad 
effects. Only certain fungi exert an unfavorable influence upon 
the uterus. Ergot of rye (secale cornutum), when present in 
large quantities, is an ecbolic. In all probability other auxil- 
iary causes must be present, as experiment shows that secale 
cornutum only produces contractions when labor pains are 
already present. The Ustilago family contains some fungi 
which act directly upon the uterus, as Tilletia caries of wheat, 
also Ustilago carbo and Ustilago maidis. Gerlach reports the 
following observation : Animals aborted the second and third 
day after eating the almost black chaff of rusty wheat, Tilletia 
caries ; in five weeks, ten cows aborted which had eaten more or 
less of such chaff. 

According to Haselbach, eleven cows aborted in eight days 
after having been fed with corn covered with rust. 

[Experience in this country and my own observations 
failed to prove the abortive properties of Ustilago muidis. 


—W.| 


ABORTION jh i | 


After a wet summer, when the hay is put up improperly, 
the conditions for the development of fungi is especially favor- 
able. Many fungi in themselves are unable to produce abor- 
tion, but, by their action upon the albuminous bodies of the 
plant, certain substances producing abortion may be generated 
(Stockfleth). 

It has been observed that cows aborted which were fed 
with beet molasses, a syrupy, dark-brown mass remaining 
behind after crystallization of the sugar. Schneidemuhl thinks 
that the cause of this is found in the great amount of potassium 
and sodium salts. The feeding of clover which has been limed 
is also said to have produced abortion (Schneidemuhl). 

(b) Medicaments introduced into the circulation, which 
act especially upon involuntary muscles, which may produce a 
hyperemia of the ovaries. Drugs of the first kind are: pilo- 
carpine, eserine and creolin (Frohner). Their use is contra- 
indicated in cows advanced in pregnancy. To the second group 
belong: cantharides, mustard seed and many acrid diuretics. 
Rueff states that 3 kg. of pulverized rape-cake may be given 
with impunity to a grown cow, but when mixed with water 
until sloppy may be injurious and cause abortion. According 
to J. Lehmann, as a result of the soaking, an etherial oil similar 
to mustard oil is developed. When such slops are exposed to 
the air for a while, they are no longer harmful, as the oil 
evaporates. 

3. All mechanical causes. Tiong drives, railroad travel, 
especially when the animals are crowded, may produce abor- 
tion. Here it may be the result of mechanical insults, or 
follow disturbances as mentioned above (1 and 2). 

Vaginal exploration in the cow is hardly connected with 
any danger. Of course a rough exploration may produce 
abortion, but otherwise it rarely follows. The same refers to 
cows which hook each other or when they fall (Beel). 

With regard to abortion from metrorrhagia, see “ Metror- 
rhagia.” 

4. Previous abortion is said to be prone to produce abortion 
in the succeeding period of pregnancy. Although it happens 


112 BOVINE OBSTETRICS 


that a cow aborts first in the seventh month, the following 
year in the eighth month, and the next year carries the calf the 
regular time, such cases are the exception in the non-infectious 
abortion. A premature expulsion occurring earlier than a pre- 
ceding abortion is mostly due to a diseased placenta. 

5. The influence of the bull. Kretschmar reports a case 
where all cows served by a certain bull aborted and retained 
the placenta. This bull came from a cow which aborted 
repeatedly and almost each time retained the afterbirth. Some 
think that heavy and large bulls might produce abortion. 
Stockfleth thinks that crossing of different breeds, especially 
with shorthorn bulls, is not accused without foundation as a 
cause of abortion. 

Symptoms.—Abortion in the cow usually occurs between 
the fourth and seventh month of pregnancy. Expulsion of the 
foetus in the third and fourth or fifth months is usually not 
accompanied by any striking phenomena. Cows at pasture 
abort without knowledge of the owner. When happening in 
the stable or when watched at pasture, this premature abortion 
is recognized by various symptoms. 

One of the first symptoms announcing abortion is the 
changed lacteal secretion. The quantity decreases and quality 
changes; the milk is more like colostrum. In heifers, this 
symptom of course is wanting, as they do not give any milk. 
The general state of health is but little, if any, changed ; the 
cow eats well, ruminates ; defsecation, micturition, pulse, tem- 
perature, are all normal. In some cases the animal is restless 
and the general health somewhat disturbed. When the foetus 
is dead some days, but not yetexpelled on account of the insuf- 
ficient dilatation, a bloody mucus flows from the vagina and 
feeble pains are noticeable now and then. At this period of 
pregnancy it is difficult to distinguish between weak uterine 
contractions and straining in consequence of retarded hard 
defeecation or difficult micturition. 

The expulsion of the foetus and the period of cestrum 
always coincide (Franck); the hypermmia of the genitals then 
present leads to uterine contractions. The connection of the 


ABORTION 113 


chorion and uterine mucosa is mostly obliterated, so that the 
foetal envelopes follow the birth of the calf—a very favorable 
factor, considering the process of involution about to follow. 

The expulsion of a small foetus at this period of gestation 
as a rule offers no difficulties. A definite position does not 
exist at this time; the foetus is usually born in the anterior 
presentation. The process of involution now terminates 
quickly ; for three or four days after parturition a little hemor- 
rhagic mucus is discharged from the vulva. This ceases and 
the cow again is normal. In the heifer the whole process is so 
trivial that none but an observing attendant would notice it. 

Abortion occurring in the second half of pregnancy gives 
rise to more characteristic symptoms, and the general state of 
health often is disturbed, even when but temporarily. Abortion 
frequently happens in the seventh month. 

Premonitory symptoms.—Cows which are still giving milk 
at this time—usually the case in localities where they are dry 
only for six weeks—decrease in milk, and its color and consist- 
ency closely resembles colostrum. This is the first sign induc- 
ing the attendant to watch her. At this time he can usually 
observe more, if not on the same day, then on the following one. 
A limited infiltration of the broad pelvic ligaments has taken 
place, their posterior border is no longer tense and the liga- 
ments begin to sink down. In some cases the vulva is tumefied, 
and when the animal is emaciated the flanks are fallen in. 
Abortion is often preceded by vigorous movements of the foetus. 
These are reflex movements and are caused by the asphyxiated 
state of the foetus, due to an accumulation of carbon dioxide in 
the circulation of the placenta. A rather sudden swelling of the 
udder at this time is seen in primipare, which suggests an 
approaching abortion. After these symptoms have extended 
over two, sometimes three days, the prodromes of parturition 
manifest themselves; in the beginning the animal strains a 
little now and then, confining itself to the uterine contractions ; 
later the abdominal muscles assist, and regular labor pains set 
in. The premonitory symptoms may escape the attendant, 
while the latter phenomena induce him to fear abortion. 


114 BOVINE OBSTETRICS 


Expulsion of the Feetus.—By means of the uterine contrac- 
tions, the cervix uteri is opened and a part of the foetal mem- 
branes in the shape of a bladder are driven into the genital 
canal, in the same manner as in normal parturition. The cervix 
uteri is dilated less, while at the same time forms no obstacle 
to the rather small foetus. We may say that in general the 
same phenomena accompanies abortion as a regular birth, only 
of lessened intensity. Asa rule, the expelling forces need not 
be supported by traction. The calf is often found lying in the 
pasture, where the mother, of course, did not receive any aid. 

The presentation of the calf may be normal; that is, the 
head rests upon the anterior extremities. Slow and insufficient 
dilatation often leads to deviations, as a malposition of the 
head or forelegs flexed at the knees. As a rule, reposition is 
easy. The afterbirth usually is retained for some time after 
birth of the calf. There are cases where the foetal membranes 
(secundinz) are expelled six to twelve hours after parturition ; 
their expulsion mostly is retarded, which may produce many 
disturbances erroneously attributed to abortion. 

Why is the placenta retained as a rule? First, because 
the uterine contractions are insufficient to detach the villi of 
the foetal placenta from those of the maternal placenta; second, 
bacause the union of the two placente is too firm. We know 
that even the physiological expulsion of the afterbirth in the 
cow takes place under less favorable circumstances than with 
other domestic animals. In abortion, those factors which 
normally bring about expulsion in three to four hours after 
parturition, act insufficiently. When abortion is a sequel to 
diseases of the placenta, where, as the result of a placentitis or 
apoplexia placentz, the villi become united by fibrous tissue, 
retention of the placenta after parturition is a rule, and manual 
removal of this afterbirth becomes exceedingly difficult. 

As a consequence of the retention of the placenta after 
parturition, metritis, acute puerperal infection, leucorrhoa and 
pyemia may arise. (See “ Retentio Secundinarum. ”’) 

Prognosis.—Abortion in the second half of the period of 
gestation usually does not endanger the life of the animal. 


ABORTION 115 


The prognosis may therefore be favorable. The cause of an 
abortion is of course of great importance in making a prognosis. 
Although abortion in itself usually takes a happy termination, 
it may become dangerous when followed by the above named 
diseases. 

Therapeutics.—When a cow is once disposed to abort, 
assistance must confine itself to those measures laid down 
under normal parturition. The foetal envelopes should not be 
torn too quickly, anyway not until the cervix uteri is sufficiently 
dilated. When the whole foetal water is already discharged, 
frequently the case when the veterinarian is called too late, 
and the cervix uteri hardly sufficiently dilated to pass the hand, 
an infusion of warm water, slimy decoction, or oil is indicated. 
They replace the escaped foetal liquids, and may be doubly 
useful, by lubricating the passages and by preventing the uterus 
from contracting too firmly upon the foetus and thus rendering 
difficult attempts at reposition. In most cases our advice is 
only then requested, after parturition has begun. Should it be 
the case that from former experience with abortion in a herd 
the attendant imagines to notice premonitory phenomena of 
abortion, treatment may be instituted. Harms recommends 
camphor and opium. 

[The administration of viburnum prunifolium in these 
cases, in doses of 30 cc. every hour until 120 cc. have been 
given, yielded admirable results in some animals about to 
abort, while in others it had no effect whatever, no doubt 
depending on the cause of abortion.—W. |’ 

The circulation must be equalized by thoroughly rubbing 
the belly and legs; the hindquarters should be raised. Preg- 
nant cows, fatigued by long drives or railroad travel, showing 
the first indications of abortion, receive the above treatment. 


II.—INFECTIOUS ABORTION. 


On page 108 it was shown that stationary abortion need not 
necessarily be infectious. Strebel reports that during the wet 
years, 1878 and 1879-80, 20 to 60 per cent. of all pregnant cows 
aborted in the canton of Freiburg.. The stables, which were 


116 BOVINE OBSTETRICS 


clean, had a healthy location. Strebel looked upon as causes 
of this abortion, first, tainted food, and second, an infection 
from a decomposing placenta, from which an agent developed, 
acting especially upon the gravid uterus. 

This was also Bouley’s opinion. He insists that a septic 
agent results from the decomposing placenta of a cow which 
aborts, and which, transferred to other pregnant cows, produces 
abortion (St. Cyr and Violet). 

Already in 1812 Cruzel enumerated infection among the 
causes of abortion. 

Rueff is of the opinion that abortion is caused by a sort of 
contagion; and therefore in his text-book on obstetrics, as far 
back as 1878, proposes prophylactic therapeutics ; which is still 
of value to-day and needs but little improvement with regard 
to more recent investigations. 

Experience taught long ago, that abortion, when once 
occurring in a stable, may spread and produce abortion among 
many cows. It was also known that the purchase of cows from 
an infected stable imported the disease. The manner in which 
abortion spread in a stable where but one case had put in its 
appearance, by going from one cow to a neighboring cow, etc., 
put the stamp of infectiousness upon enzootic abortion, 
although at that time nothing was known about the contagious 
agent. 

Briiuer was the first to prove by experiments that the 
vaginal mucus of cows which had aborted in a stable where 
enzootic abortion existed, when transferred to the healthy 
vaginal mucous membrane of other pregnant cows, caused them 
to abort; abortion took place in nine to twenty-one days. 
After abortion he found cocci in the vaginal discharge as well 
as in the foetal waters. 

Franck found micrococci in such vaginal mucus, and looked 
upon them as the infectious material. 

Lehnert obtained the same results as Briiuer. Briiner 
later took cotton and saturated it with foetal water and mucus 
of the vagina of a cow which had aborted twelve hours prev- 
iously. This cotton was placed for ten minutes into the vagina 


ABORTION 117 


of pregnant cows; in nine to fifteen days (period of incubation) 
eleven cows aborted. These experiments show that the infec- 
tion may be transmitted by intermediaries. As such, we name: 
Straw, manure, urine, ropes, stable paraphernalia and the arm 
of the operator. 

Franck reports that a cow which was examined for preg- 
nancy per vaginam aborted after a decomposing placenta had 
been removed that day (although the arm was thoroughly 
cleansed. ) 

Sand, who collected the reports of many Danish veterin- 
arians, also mentions a case where abortion was transmitted by 
a piece of afterbirth of a cow which had aborted. 

The transmission of the infectious material by the bull is 
corroborated by many observers. Danish veterinarians report 
striking examples. One breeding establishment introduced a 
bull which while coming from a healthy herd had been for 
several days at a farm where abortion existed, but did not come 
in direct contact with the cows. This bull was placed at his 
new home among the old cows which he was to serve while the 
young cows were served by a young bull on the other side of 
the farm. Of the old cows, twelve to fourteen aborted, the 
young cows served by the young bull completing their period 
of gestation. Later investigation showed that the old bull had 
served some of the cows of the infected stable. Abortions 
persisted in this case for two years (Nygaard, Sand). 

The experiences of Danish veterinarians tell us that cows 
far advanced in pregnancy, when placed into an infected stable, 
calve the first year at the regular time, but abort the following 
year. Many examples have been enumerated, that in certain 
divisions where abortion was stationary for two or three years, 
only the first cows aborted. Experience further teaches that 
the purchase of new cows and the sale of the aborting cows is 
useless in a stable with stationary abortion. The newly bought 
cows invariably abort the following year. 

Nocard states that in Michel at Azy abortion was permanent 
for twelve years, and every year one-third of the cows aborted. 
Every year abortion took place at a later period, so that in the 


118 BOVINE OBSTETRICS 


last year, 1884-1885, no cows aborted. Of the calves born at 
the regular time fourteen out of thirty-two died one or two 
days after birth with diarrhoea. According to Nocard, this 
diarrhoea was produced by the same agent which was the cause 
of death in those calves dying immediately after a period of 
pregnancy of seven to eight months. 

AStiology.—Already the above shows plainly that enzootic 
abortion is an infectious disease. The manner in which it 
oceurs and spreads, as also the experiments, prove it conclu- 
sively. Bratier already detected cocci in the vaginal discharge 
of cows which had aborted and in the foetal water. Franck 
thought that the micrococci present in the inodorous mucus of 
the vagina represent the infectious material. 

Nocard made exhaustive experiments in regard to the 
eetiology of infectious abortion. . 

Tn the first place, it was his intention to answer the follow- 
ing questions: (1) Is infectious abortion a disease common to 
the pregnant cow? (2) Is it a disease of the genital organs of 
the mother? (3) Is it a disease of the foetus and its envelopes ? 
Tn the first two instances the foetus might play a passive role. 

He dissected cows which had just aborted, primipare 
which were about to abort, and cows which aborted the pre- 
ceding year and had not conceived since that time, although 
repeatedly served. In microscopical examinations of the 
uterine milk, Nocard found, besides epithelial cells and leuco- 
cytes, a great number of short bacilli isolated or in pairs; in 
the puriform mass, which represents itself as a dirty-whitish 
fluid on the lower surface of the cotyledon, cocci, either 
isolated or in chains of 3, 4, 5. 

In the uterine milk bacilli were more numerous than cocci. 
The liquid attached to the uterine mucosa contained both in. 
equal quantity. When inoculating bouillon, the uterine milk 
furnished pure cultures of short, thick, straight bacilli in 
twenty-four hours. Bouillon inoculated with the puriform 
mass gave a mixed culture of micrococci and bacilli. The 
media remained sterile when inoculated with milk and blood. 
The second group of the experiments consisted of inoculating 


ABORTION 119 


bouillon and gelatine with uterine milk and amniotic fluid of 
primipare about to abort; media were also inoculated with 
blood. After forty-eight hours the blood inoculations were 
sterile ; the uterine milk furnished the bacilli, and the amniotic 
fluid a delicate coccus in bunches or short irregular curved 
chains. 

The third examination was made on a cow which had 
aborted eight months previously and which had been served 
once a week, without conceiving. The mucous membrane of 
the uterus was red, moist; the removed mucosa contained a 
liquid of acid reaction, swarming with bacteria, growing 
freely in bouillon. Comparative tests on pregnant cows 
and those which had calved repeatedly showed that the 
reaction of the uterine mucus in the latter is not acid nor 
contains micro-organisms. The intestinal contents of fourteen — 
ealves either born dead or dying soon after abortion were full 
of bacteria, confirmed by cultures and staining. In a normal 
foetus, which has neither breathed nor partaken of any milk, 
the intestinal tract is sterile. 

This explains the cause of the profuse diarrhoea of calves 
which are born alive at an advanced period of gestation and 
die soon after parturition; possibly also the simultaneous 
appearance of dysenteria neonatorum and abortion in the one 
and the same stable. In three calves which died in the first 
week after they were born with dysenteria neonatorum, Nocard 
inoculated calf’s bouillon with pieces of the medulla oblongata 
and got cultures which were identical with those obtained upon 
the same medium by inoculations with the medulla oblongata 
of premature births. He asked himself the question whether 
the peculiar bellowing mentioned by many observers, and 
supposed to announce the approaching death of the calf, could 
be explained by these low organisms from the medulla oblon- 
gata. The cause of it, same as in rabies, may be found in the 
paralysis of the vocal cord. 

The exact researches of Nocard have materially advanced 
the etiology of infectious abortion. He summarizes the results 
as follows : “ Infectious abortion appears to be a disease of the 


120 BOVINE OBSTETRICS 


foetus and its membranes, caused by a low organism, and which 
do not directly concern the cow.” 

Galtier, Poncins and Ory observed cases of enzootic abcor- 
tion, which led them to the deduction that infectious abortion 
is the result of a constitutional disease of the cow, transmitted 
to the foetus and caused by bacteria. Their experiments and 
observations were made on a farm where abortion was enzootic 
for 20 years. 

Here also the young animals born at the right time 
frequently became ill soon after birth, showing symptoms of 
broncho-pneumonia and enteritis, occasionally nervous symp- 
toms; they had a fetid diarrhoea and sometimes convulsions. 
The grown unimpregnated animal, according to their opinion, 
bears the disease without noticeable symptoms ; but as soon as 
pregnaney occurs the pathogenic agent finds a favorable 
medium in the tissues of the young. Inoculations with por- 
tions of the aborted foetus or foetal envelopes, the disease was 
transferred to swine, sheep, rabbits, goats and guinea-pigs. 
The diseases following those inoculations were mainly pneu- 
monia and enteritis. 

Prof. B. Bang (Copenhagen), together with his assistant, 
Veterinarian Stribolt, has made many examinations in regard 
to infectious abortion, and obtained fine results by his highly 
interesting experiments. Owing to his kindness, I am able to 
reproduce verbatim his personal communication : 


Enzootic abortion is the result of a slow uterine catarrh caused by 
asp vific, very small bacillus. When a pregnant cow is slaughtered at the 
time when the first symptoms of an approaching abortion manifest them- 
selves—that is, before dilatation of the cervix uteri—a considerable amount 
of sero-purulent exudate is found between the wall of the uterus and the 
foetus. ; 

The exudate, of dirty aspect and almost inodorous, separates into a 
serous fluid and thick muco-purulent sediment, when put into a glass and 
left to itself. The exudate contains the pure culture of a small organism 
which at first sight appears to be a coccus ; closer examination shows that 
it isa small punctated bacillus, which stains especially well. It takes up 
the ordinary stains; for instance, Loffler’s Blue. The bacteria lie either 
isolated or are found in enormous numbers in thin large cells (desquamated 
epithelium), giving them the appearance of micrococci, being aggregated so. 


ABORTION 121 


closely. The bacilli do not grow in ordinary agar or gelatin agar, develop 
poorly in bouillon with glycerine, better in bouillon glycerine mixed with 
serum. They grow best in gelatin-agar-serum (that is, two parts gelatin 
mixed with one part serum). A culture raised in this medium in a high 
glass (Liborius) has the peculiarity, that its small colonies only develop in 
a certain zone, that is, a little below the surface. Therefore, it developes 
in the zone of aerobic organisms, but not on the surface. 

Strange to say, it develops on the surface when pure oxygen is 
allowed to flow over the congealed liquid, after which the glass is sealed 
with paraffin. This characteristic, of course, is of great assistance in 
identifying the bacillus. 

The introduction of a pure culture into the vagina of a pregnant cow 
produces abortion in 10 weeks; the same pathological changes are then 
found as in the spontaneous cases of enzootic abortion. In two experi- 
mental cows Prof. Bang introduced cultures twice during the period of 
incubation; thus it is possible that the time is less than ten weeks; he pre- 
sumes, however, that this time is correct and that the first inoculation was 
the effective one. 

In the foetal envelopes a considerable gelatinous cedema is constant 
between chorion and allantois. 

In practice, we can readily recognize enzootic abortion by this 
peculiar advance and the immediately following dirty but inodorous 
discharge. 

The intestinal tract of the foetus at times contains the pure culture of 
the same bacillus. The organisms are very resistant and remain alive for 
seven to ten months when kept in a refrigerator. 

Eradication.—1. Immediate removal of the pregnant cow from the 
stable, as soon as she offers premonitory symptoms of abortion, to prevent 
discharge of the infected material into the stable; destruction of the 
afterbirth, disinfection of the uterus, etc. 

2. A special bull must be used for the cows which aborted, as the bull 
no doubt is often the intermediary of the contagion. ’ 


Symptoms.— When infectious abortion has repeatedly 
happened in a stable, or has returned year after year, the pre- 
monitory indications of an early expulsion are noticed at an 
early period. The first changes are in the composition of the 
milk, which resembles colostrum. When abortion occurs in 
the seventh month and the animal is dry, approaching abortion 
is usually not so quickly perceived; an observing attendant 
recognizes it by the swelling of the udder. At the same time 
a reddish or brownish-red vaginal discharge is seen ; sometimes 
it is more purulent or dirty white. The vulva is slightly tume- 
fied, the ligaments sunk in a little. Many observers noticed a 


122, BOVINE OBSTETRICS 


limited dry herpetic exanthema around the root of the tail, 
anus and vulva (Brauer, Schneidemihl). This exanthema is nct 
pathognomonic, as it may be frequently seen in a cow witha 
retained decomposing placenta and also in stables where no 
infectious abortion prevails or ever existed. After the dis- 
charge from the vagina has lasted three or four days, and the 
other symptoms, as the changed quality of the milk, swelling 
of the vulva, have been present sometimes for several days 
before that, follows without severe pains, the expulsion of the 
calf. Up to this period the general state of health seems to 
suffer but little, the animal feeds well, ruminates, feeces are a 
little harder than usual, otherwise mostly normal. 

After parturition, which usually takes place without aid, 
the placenta is retained. In many cases they are expelled 
within one half to one day after birth ; when this does not occur 
they begin to decompose at the third or fourth day. Now 
phenomena manifest themselves suggestive of a generally dis- 
turbed health. Temperature rises up to 40° to 41°; appetite is 
wanting ; rumination is irregular ; horns, ears, lower extremities 
are cold; pulse usually normal. Exploration reveals that the 
cervix uteri is still sufficiently open to permit the introduction 
of two to four fingers. With patience and rotary movements 
of the cone-shaped hand, one passes through the cervix into 
the uterus. The envelopes are still found attached to the 
cotyledons, the uterus is but little contracted, the uterine 
cavity full of a stinking chocolate-colored liquid, appearing 
upon the arm and hand when retracted as fimbriated streaks. 
The walls of the vagina and uterus are hot. The exploration 
is painful to the animal. Matters are not always as bad as this. 
In most cases the placenta is expelled at the fifth or sixth day, 
followed for a long time by a badly smelling lochial excretion, 
which later winds up with a muco-purulent discharge. After 
expulsion of the afterbirth, the symptoms cease and the animal 
recovers. But conception does not take place as long as the 
muco-purulent discharge persists. In some cases sequels 
appear, as septic metritis, metro-peritonitis and pyemia, 
usually in the form of a polyarthritis pywmica. 


ABORTION 123 


Prognosis, on the whole, is favorable for the cow. With 
proper care most cases terminate well. 

Therapeutics. —While discussing the etiology, it was 
remarked that lessened powers of resistance of the body form a 
predisposing factor. Prophylaxis consists, therefore, primarily, 
in the prevention of such a state by rational hygiene in the 
widest sense of the word. Further prophylaxis is to prevent 
infection and to destroy the infectious material either when 
existing without or within the body. As regards the latter, 
the experience of many veterinarians teaches the following 
rules : 

1. A cow which has aborted must be isolated immediately. 
Whenever possible, all the other pregnant cows should be 
zemoved from that stable. In many cases this is impossible 
for economic reasons, and the aborting cow is removed 
instead. 

2. The foetus, which arrives either dead or dies soon after 
delivery, is burnt. When the calf is still living, it must be 
isolated and its faces must not remain in the stable. 

3. The placenta of a cow should be removed by hand and 
burned unless expelled by uterine contractions., The uterus is 
then irrigated with a two per cent. creolin solution, to be 
repeated for several days. 

4. The stall occupied by the patient is cleansed, all hay 
and straw removed, and the whole stall thoroughly dis- 
infected. 

5. All manure lying behing the cows must be removed 
twice daily. The floor is to be rinsed with water every morn- 
ing after removal of the feces, and should be sprayed once a 
week with a three per cent. solution of copper sulphate. 
Should the infectious agent already have entered the vulva or 
vagina, it is still possible to reach it. 

Besides the therapeutic measures already given, it is advis- 
able to act as follows: 

(a) Once daily, the tail, anus, vulva, internal and posterior 
surface of the thigh must be washed with a two per cent. 
creolin solution. 


124 BOVINE OBSTETRICS 


(b) Into the vagina of the pregnant cows once weekly a 2 
per cent. blood-warm creolin solution is to be injected. In the 
stable the greatest cleanliness must be observed. 

Nocard recommends for the disinfection of the stable floors 
once a week a 4 per cent. solution of copper sulphate. For the 
vaginal injections and cleansing of the external genitals and 
their neighborhood, he suggests the following solution : 


Hydrarg. bichlor. COrrosiv........+e++eeeeee recess 5.0 
Spiritus diluti........ 2... e eee eee eee eee eee teens 50.0 
Glycerin .. 06.2 cee s aie eweinceles «ven aie Thc gk Mean 
Aqua destillatze .......... eee cece renee eee rere neces 20 1. 


Nocard advises to practice his prophylactic therapeutics 
immediately after conception in those stables where abortion 
reigns. 

It is of special importance not to breed cows until the 
vaginal discharge has entirely subsided. Otherwise there is 
danger to infect the bull, who may transmit abortion to other 
cows. 

Reindl recommends to fumigate the stable with sulphurous 
acid, to whitewash the walls and stalls and posts, adding } to 1 
kg. of crude carbolic acid to every 20 1. of whitewash. He 
orders irrigation of the vagina of infected cows, heifers and 
calves, twice weekly, with a solution of 1 per cent. acidum 
carbolicum liquefactum, and 1 to 2 per cent. solution of sodium 
carbonate ; also treats the prepuce of the bull in the same way. 
Reindi insists to have better results with this treatment than 
with ecreolin, carbolic acid or sublimate solutions. He thinks 
it is in consequence of the alkaline solution. 

Briiuer, who first experimentally transmitted abortion to 
pregnant animals, describes his prophylactic therapeutics as 
follows: Between the fifth and seventh month of the period of 
gestation, each cow receives hypodermically 10 to 15 g. of a2 per 
cent. carbolic acid solution, to be repeated every 14 days. The 
tail and external genitals are kept clean and washed with a 5 
per cent. carbolic acid solution several times weekly. Many 
have tried Briiuer’s method and report surprising results. 
Others, on the contrary, have seen bad results from the injec- 


MUMMIFICATION OF THE FETUS 125 


tions. Whenever disinfection of the floor of the stable and 
washing of the external genitals and tail with carbolic acid or 
ereolin solution were added to the hypodermic injection, the 
results were most favorable. 

R. Boer Hzn and J. M. Billroth, in Friesland and Northern 
Holland, have obtained excellent results from Brauer's injec- 
tious, in stables where abortion was permanent. 


Lid ic 
DISEASES OF THE FETUS AND ITS ANNEXES. 


1.—Mumumification of the Foetus. 


The developing foetus may die or undergo many changes 
during uterine or extra-uterine pregnancy. The etiology will 
show that the variety of changes depends on different circum- 
stances. Only those changes are discussed here occurring in 
intra-uterine pregnancy. In regard to the decomposition 
taking place in the foetus of normal size, and which may lead to 
dystokia, I refer to the chapter on “ Emphysema of the Foetus.” 

Definition. By mummification, that state of the dead footus 
is understood, where the body has experienced a dry necrosis. 
The foetus has dried up, the tissue plasma is apparently 
resorbed, while the macroscopic and microscopic structure of 
the tissue is still preserved for some time. 

The whole forms a solid, hard mass, on which the various 
parts of the body can still be recognized; therefore the name 
stone fetus, lithopeedion, osteopedion (Numan, Franck, Forster, 
Cohnheim). 

Such mummified foetuses are frequently seenin cows. Asa 
rule they are only observed on slaughter, and offer different 
aspects depending on the time during which they remained in 
the uterus. This interval, starting with conception, is twelve 
months to two years, and sometimes even longer. Among 
others, Figuier reported a case where the mummified foetus 
inhabited the uterus five years. 


126 BOVINE OBSTETRICS 


A&tiology.—Mummification occurs after death of the foetus 
only under following conditions: 1. When the air is absolutely 
excluded. 2. When expulsion is prevented. 

The foetus usually dies between the fourth and sixth 
month; in some cases sooner, rarely later; or at the end of 
gestation death may be caused by interference with the circu- 
lation,—for instance, after torsion of the uterus (torsio uteri) ; 
then expulsion is also prevented (Franck). But diseases of 
the foetus and disturbances in the composition of the blood 
may cause intra-uterine death of the foetus. Besides torsio 





Fig, 17.—Lithopeedion. 


uteri, other disturbances making expulsion impossible, may be 
auxiliaries, obliteration of the os uteri, wanting labor pains due 
to fatty metamorphosis of the uterine muscle, adhesions of the 
walls of the uterus with adjoining organs, in consequence of 
which the contractions cannot exert their expelling powers. 
Torsio uteri is the most frequent cause. Many mummified 
calves have distinct parallel grooves on their surface from the 
folds of the twisted uterus (Franck). In extra-uterine preg- 
nancy, lithopedions may also form. (See “ Extra-Uterine 
Pregnancy.) 


MUMMIFICATION OF THE F@TUS 127 


Mummification only occurs when the air is excluded. It is 
not necessary that the cervix uteri is hermetically sealed; it 
may even be partially open, as in a one-fourth revolution of 
the uterus ; but the foetal membranes must be intact. As long as 
they are not ruptured, low organisms cannot influence the foetus 
detrimentally (Franck). Mummification of the foetus takes 
an aseptic course. Entrance of air may give rise to a chronic 
metritis, resulting in a muco-purulent exudate which is tinged 
red on account of the decomposition of the blood corpuscles of 
the venous thrombi. The entire process, on the whole, does 
not affect the cow seriously. 

Symptoms. — Death of the foetus and the labor pains 
following it are characterized by phenomena which are often 
not recognized as such and overlooked. Especially when death 
of the foetus and the prevented expulsion occur in the fourth or 
fifth month, the symptoms are of limited duration and of little 
intensity. 

The only thing observed in such a cow is the following - 
She does not feed well, ruaminates slowly or not at all; the hard 
feeces are expelled in small quantities and with straining; 
micturition is frequent but limited in amount ; the left flank is 
slightly bloated. Occasionally the animal kicks with its feet 
against the belly, or stamps with the hind legs, frequently seen 
in intestinal invagination. 

The diagnosis is here usually indigestion, and the cow is 
treated accordingly. These symptoms decrease in two to four 
days or disappear entirely, and the diagnosis and treatment are 
looked upon as correct. At this period the process of mummi- 
fication begins. 

The phenomena just mentioned are caused by the contrac- 
tions of the uterus; which are less strong than in normal 
parturition, as the expelling powers of the uterus are limited. 
The pains, now and then assisted by the abdominal muscles, 
were unsuccessful because some disturbance interfered with 
expulsion. After the uterus eventually becomes fatigued 
through the repeated contractions, and a few of the fcetal 
placent separate from the maternal placenta, the foetal liquor 


128 BOVINE OBSTETRICS 


is very slowly resorbed, so that after a while the foetal mem- 
branes are closely moulded to the feetus. The walls of the 
uterus contract and the mucosa undergoes many changes. 
The cotyledons undergo fatty degeneration and atrophy, they 
lose their peduncles, become smaller, appearing finally as long 
yellowish spots upon the mucosa. The foetal plasma is 
absorbed, and the skeleton, covered by a parchment-like tissue, 
remains behind. This process is not characterized by a single 
symptom. The cow appears perfectly well. 

Expulsion of the foetus is manifested by the following 
phenomena: After the animal has been considered unimpreg- 
nated for some time, months, possibly years, and has not been 
in heat all that time, symptoms indicating cestrum set in 
(Franck). The cow strains a little ; a more or less dark colored 
discharge mixed with blood flows from the vagina. When the 
vagina is explored, the mummy is found in the. vagina or uterus, 
the os uteri being sufficiently opened to allow entrance of the 
hand into the uterine cavity with a few rotary movements. 
The uterine contractions are, of course, very feeble. The pro- 
cess of involution injured uterine contractility, and consequently 
expulsion is slow, the foetus remaining in the vagina often for 
days. The vaginal discharge first induces us to make an 
examination per vaginam. 

Therapeutics.—W hile discussing the symptomatology it was 
stated that the fruitless efforts of the mother to give birth may 
escape attention and that no aid is called for on account of the 
short duration. Close observation of the symptoms might 
confirm by rectal or vaginal examination an eventual torsio 
uteri. (See “Torsio Uteri.”) During expulsion we must 
endeavor to hasten it by cautious extraction and lubrication of 
the genital canal. This is usually not difficult. As after treat- 
ment, antiseptic and astringent irrigations, on account of the 
insufficient contraction of the uterus, are to be employed. 
Should the uterus contract after expulsion and the foetus and 
membranes be inodorous, irrigations may be omitted. The 
discharge from the genital canal following expulsion may 
be of long duration. In most cases it is of chocolate color 


MACERATION 129 


the first few days, later purulent, muco-purulent and finally 
mucous. 


2.—Maceration. 


Definition. —Maceration, same as mummification, is a 
necrotic process. While mummification is somewhat of a drying 
out process, maceration consists of a colliquation (liquefac- 
tion). With it the development of low organisms go hand in 
hand, causing at the same time a purulent metritis. 

Although the boundary line cannot be closely drawn 
between mummification and maceration, there is nevertheless a 
marked difference in the more pronounced cases of a mummified 
and macerated foetus. Mummification produces a firm mass, 
maceration dissolves all soft parts, so that the bones of the 
skeleton fall apart. In complete maceration even the epiphyses 
and diaphyses separate; the bones of the head become discon- 
nected at their sutures; the individual bones of the skeleton 
rest in the uterine cavity amidst a muco-purulent mass. 

Abtiology.—Maceration usually occurs in the fourth to 
sixth month of pregnancy, rarely later. Disturbances causing 
death of the foetus, and at the same time interfering with 
expulsion, may lead to maceration, provided air enters. Macer- 
ation often follows when the foetal envelopes have ruptured 
and the dead foetus is retained in the uterus. 

Course-—The dead foetus liquefies and falls to pieces. The 
mucosa of the uterus develops a chronic inflammation, with a 
muco-purulent exudate liquefying still further the already 
softened foetus. This chronic inflammation not only attacks 
the mucosa, but also the submucosa, muscularis, and serosa, 
so that the uterine walls become thickened and may develop 
purulent foci (Franck). 

Under favorable conditions the uterus behaves as the wall 
of an abscess ; the changed mucosa and submucosa represent 
the pyogenic membrane, protecting the body aguinst further 
infection. But it happens that by continuity a metro peritonitis 
sets in, leading to adhesions between the uterus and adjoining 
organs, as the rectum, bladder, intestines and abdominal walls. 


130 BOVINE OBSTETRICS 


Weber tells of a case of maceration where adhesions 
between the uterus and abomasum took place. The latter was 
probably perforated by a macerated bone, as a consequence of 
which food was found in the uterus. In the cow, cases of 
maceration are, as a rule, followed by a purulent metritis and 
parametritis,—even adhesions,—but expulsion of the foetus 
through abnormal passages must be rare. 

It is the rule that the bones are evacuated via the cervical 
canal, or that the patient dies before it can occur with pyzemia. 





Fig, 18.—Macerated Foetus. 


Symptoms.—Now and then a small amount of thick pus is 
discharged from the vagina, so that the owner, imagining the 
animal not to be pregnant, thinks of leucorrhoea. While the 
pus is evacuated, bones are also discharged, sometimes lying 
in the vagina, amidst a purulent mass, days and weeks. The 
whole process may persist for a long time, months may pass, 
before the whole of the macerated mass is expelled (Franck). 

In most eases, while offering such symptoms, the cow 
emaciates some, but seems healthy otherwise, eats well, rumin- 
ates and gives a fair amount of milk. Straining is only occa- 


MACERATION 131 


sionally noticed, so that the veterinarian is called only on 
account of the vaginal discharge. A local examination reveals 
the facts. The os uteri is somewhat dilated, two or three 
fingers may enter when necessary, also the hand by a few rotary 
movements. The bones of the foetus are found in the uterus 
surrounded by thick cream-like pus ; the mucosa of the uterus 
is roughened and the walls a little contracted. In some cases 
the os uteri is closed and a few bones are found in the vagina. 
It happens occasionally that the cervix uteri opens a little to 
expel some portions of the foetus. This slight dilatation prob- 
ably corresponds with a period of cestrum, which may appear 
regularly with such patients. According to Franck, conception 
is possible. 

In other cases the process of maceration is complicated by 
the absorption of putrid materials. The purulent inflammation, 
which migrates from the mucosa to the muscularis and serosa, 
caused thrombosis of the veins of the uterus. The uterus is 
also predisposed to a generalization of this process on account 
of the reticulated lymph system between its longitudinal and 
circular layers. 

The thrombi decompose after invasion of the pathogenic 
bacteria, enter the circulation and may produce a metastatic 
pheumonia or a polyarthritis pyzemica, which has been ob- 
served several times. 

Prognosis.—The course is usually favorable when the pro- 
cess of maceration has advanced to such a degree that perfect 
dissolution has taken place, the bones enclosed in a mass of 
pus, some pieces already discharged from the uterus, without 
disturbing the general health of the cow; a perfect recovery is 
then possible. At the same time, phenomena indicating the 
resorption of putrid material into the circulation make the 
prognosis unfavorable. Such symptoms are: Arthritis of the 
tarsus, carpus or femoro-tibial articulation and metastatic 
pneumonia, usually of a chronic course, characterized by ema- 
ciation, cough, ete. 

Therapeutics.—W hen the attendant or owner has observed 
a purulent vaginal discharge for some time, possibly the expul- 


132 BOVINE OBSTETRICS 


sion of bones, and the attending veterinarian detects on exam- 
ination the status quo, his first duty consists in the removal of 
all foreign bodies from the vagina or uterus. In most cases 
the purulent flow persists for a time, gradually decreases, 
becomes mucous and finally ceases. Irrigations of the uterus 
with a2 per cent. alum solution are indicated. A subcutaneous 
injection of ergot (extracti secalis cornuti, 5.0; glycerini et aq. 
ana, 5.0) should be given to stimulate uterine contractions. 


, 


3.—Anomalies in the Umbilical Cord. 


Anomalies of the funis have been investigated but little in 
the cow. It probably occurs more frequently than is generally 
accepted. In many a case death of the foetus may be caused by 
it, although not detected. 

The accumulation of Whartonian gelatine on the funis, the 
so-called false knots which are frequently seen in man, while 
of little importance, I have never been able to find in a great 
number of foetuses examined with that view; the true knots of 
the umbilical cord, produced by a rotation of the foetus around 
the transverse axis, have also not been observed in our domestic 
animals. 

They are credited with causing death and early expulsion 
of the foetus. Spontaneous amputation of an extremity from 
constriction of a part by the umbilical cord is very rare (G. 
Sand and Nocard). 

How far varicose umbilical veins are concerned in the pro- 
duction of serious hemorrhages is not yet decided in the cow. 
Further observations along this line are desirable. 

Of greater importance in obstetrics are : 


4.—Diseases of the Placenta. 


The different anatomical arrangement of the placenta of 
the cow is the cause that the disturbances of this organ are 
quite different from those of animals with a diffused placenta. 
Here diseased states concern mostly single cotyledons, so that 
any disturbances which would arise from morbid changes in 


DISEASES OF THE PLACENTA 133 


certain cotyledons are often equalized by the remaining healthy 
cotyledons. The termination of diseases of the placenta may 
become of great importance from an obstetrical point of view. 
Diseases of the placenta may be divided into three groups: 
hemorrhage, inflammation and tumors. 

The simplest form of hemorrhage is capillary apoplexy. 
It is caused by a rupture of capillaries, and in consequence of 
the extravasated blood the adhesions between single villi of the 
chorion and corresponding villi of the maternal placenta are 
destroyed. In cases of more serious hemorrhage or extravasa- 
tions, the blood mixes with the uterine milk, forming a choco- 
late-colored fluid (Franck). 

Sequele.—Limited hemorrhages and separations of a few 
cotyledons do not influence the foetus materially, as sufficient 
collateral circulation exists. The extravasated blood is absorbed 
and only alittle pigment remains, which may be seen later upon 
the chorion or placenta materna of pin-head or pea size. Such 
small hemorrhages do not give rise to clinical phenomena, 
as the cervix uteri is closed and the process an aseptic one. 
Nevertheless, another termination is possible—the formation 
of connective tissue. Out of the small amount of connective 
tissue in the villi cell tissue may be formed; in this case the 
extravasation is resorbed and adhesions between the placenta 
follows. Greater hemorrhages, the result of rupture of blood 
vessels, is accompanied by an accumulation of blood between 
the chorion and uterine mucosa. This may lead to extensive 
separations of the foetal placenta. Here the life of the foetus. 
is endangered by asphyxia, when the blood supply becomes 
insufficient. In such a ease, often a limited dilatation of the 
cervix uteri is seen, permitting the discharge of some blood 
from the vagina; this also occurs occasionally in very small 
hemorrhages. This phenomenon is known as hemorrhage from 
the uterus, or metrorrhagia. 

Symptoms.—The attendant’s attention is first attracted by 
the flow of blood from the vulva. Small hemorrhages are 
characterized by a little coagulated blood now and then, more: 
extensive ones by the discharge of liquid blood. The general. 


134 BOVINE OBSTETRICS 


health need not necessarily suffer. It sometimes happens 
during pregnancy that quite a quantity of blood is evacuated. 
After losing about one liter, the hemorrhage ceases and the 
patient recovers; but the course may be a different one. As a 
result of the hemorrhagia and loss of blood, a collateral anzemia 
of other organs sets in, the cow is attacked in a few hours by 
anemic couvulsions, and dies. Such a yirulent termination 
follows rupture of a larger blood vessel. The prognosis of such 
a hemorrhagia uteri must be a careful one. Hemorrhages quite 
small at first often develop serious sequels. This depends on 
the limited dilatation of the cervix uteri, thus interfering with 
the free flow of blood, at the same time a good deal of blood 
may be contained within the uterus. We must also remember 
that in the standing posture the extravasated blood does not 
discharge through the vagina, but accumulates in the uterus, 
and only in the recumbent position is it discharged in a 
stream. All this must be considered and a guarded prognosis 
made. 7 

T herapeutics.—W hen the local examination and the correct 
diagnosis are made, the treatment depends on the amount of 
extravasated blood. Small hemorrhages only call for absolute 
rest. Frequent explorations are dangerous, while irrigations 
are apt to destroy the life of the foetus. Therefore an expect- 
ant treatment is indicated, of course only, I repeat, in small 
hemorrhages which do not endanger the life of the mother. 
When the hemorrhage endangers the mother’s life, prompt 
interference is required. In these cases the os uteri is usually 
sufficiently dilated to pass the hand into the cavity of the 
uterus. 

The treatment next consists in producing, as quickly as 
possible, uterine contractions, and, in consequence, cessation 
of the hemorrhage. These contractions, of course, are only 
possible when the foetus has been previously removed. 
Artificial abortion, therefore, is to be instituted, together with 
application of such remedies as are enumerated under post 
partum hemorrhage (“Metrorrhagia Post Partum”), to which 
the reader is referred. 


DROPSY OF THE FETAL MEMBRANES 135 


Inflammation of the Placenta (placentitis) does not offer 
any symptoms during pregnancy which enable us to make a 
positive diagnosis. Although exact investigations have not 
been made along this line in our domestic animals, it no doubt 
happens quite frequently. 

Tapken (at Varel) describes a case where the chorion 
presented grayish proliferations of hazel-nut size, which were 
connected here and there with accessory placente. Placen- 
titis cannot be diagnosed intra vitam, although its termination 
is of great importance to veterinary obstetrics. 

Adhesion between the foetal and maternal placenta con- 
fines itself to a few places. It consists of a union of the 
connective tissue of the villi of the chorion and that of the 
villi of the maternal placenta. These adhesions are one of the 
causes of retention of the placenta. Occasionally calcium 
salts are precipitated (Cagny). Tumors on the placenta are 
rare; an occasional myxoma has been observed. 


5.—Dropsy of the Fotal Membranes. Hydrallantois, 
Hydramnios. 


In veterinary literature many cases of dropsy of the foetal 
envelopes are described. 

Brannens (St.'Cyr and Violet) already in 1829 described 
dropsy of the foetal membranes in his “Observations sur une 
hydrométre intra-membraneuse.” According to his descrip- 
tion, he was dealing with a hydrallantois, his prognosis in 
these cases being on the whole a favorable one. In speaking 
of the dropsy of foetal membranes, one usually refers to an 
extraordinary accumulation of allantoic liquor. In man, 
dropsy of the foetal envelopes confines itself to hydramnios, as 
the allantois is absent in advanced pregnancy. Hydramnios 
occurs in the cow, as I found it on post mortem of a cow 
in which dropsy of the foetal membranes had been diagnosed 
during life. The sac of the amnion contained 25 1. of a thin, 
slimy liquid. Most of the reported cases, however, refer to 
hydrallantois. 


136 BOVINE OBSTETRICS 


Definition—By hydrallantois is understood an extraordin- 
ary accumulation of fluid in the sac of the allantois, dilating 
the latter greatly and increasing the dimensions of the uterus 
to such an extent that disturbances may ensue. As much 
as 170 1. have been found (Hess). 

Attiology —Hydrallantois as a disease per se, depends on 
disturbances of the foetus or its annexes without necessarily 
involving any organ of the mother from an zetiological point of 
view. In many cases the only cause is found in the foetal 
envelopes. 

In hydrallantois, most authors—which is also my experi- 
ence—have found normally developed calves, and no dropsieal 
ones (Hess, Kammermann, Kronburger, Tapken). 

Franck insists that hydrallantois and dropsy of the cavities 
of the body of the mother are often associated. Kammerman 
also looks upon hydreemia of the female as a cause of hydral- 
lantois. This may have been observed in some instances, but 
in the majority of cases the cause does not exist with the 
mother. 

The increase of allantoic fluid may take place in two ways: 
first, by increase of fcetal urine; and, secondly, by transuda- 
tion. The former cannot be very great, on account of the 
limited activity of the foetal kidneys. At the same time, but 
little is known about foetal kidney diseases in animals. 

The second course is of greater importance—the transu- 
dation, following cireulatory disturbances of the placental 
blood vessels. According to Kitt, hydropsical changes of the 
chorion depend mainly on a stasis hypersemia started by 
torsion of one or more portions of the foetal membrane, while 
other parts still adhering to the placenta materna and in a 
normal state supply the embryo with nourishment. 

Kitt states that in ruminants crowding of the foetal mem- 
branes and torsions are very liable to occur, as the chorion 
forms fold physiologically, since the embryo and its mem- 
branes are too long for the uterine cavity during a certain 
period of gestation (Bonnet). 

Hess observed, in a post mortem of a cow suffering with 


DROPSY OF THE F@TAL MEMBRANES 1 7 


hydrallantois, an abnormal torsion of the umbilical cord and a 
marked cedema of the allantois, chorion and placenta. 

Symptoms.—The veterinarian, when called to attend to 
such diseases, finds a hydropsy of great dimensions, accom- 
panied with well marked phenomena. The first symptom 
observed by the attendant is the distension of the abdomen, 
already enormous in the sixth or seventh month. It is readily 
seen that he should mistake the abnormai distension for 
multiple pregnancy. Since the cow, in spite of good care, 
becomes more and more emaciated, he finally concludes that 
something else is the matter. 

Examination of such an animal reveals the following 
symptoms: The belly is very much distended, especially at 
its most dependent portion. At first this distention is local- 
ized in the right lower abdominal region, but later also in the 
left one. The flanks are sunk in more or less; the transverse 
processes of the lumbar vertebrie are plainly visible, the liga- 
ments are tense, the udder flabby. Usually the cow is very 
much emaciated, and appetite has decreased; later there are 
dyspnoea, costal respiration exaggerated; micturition and 
defecation often normal. Whenever the belly becomes dis- 
tended to a marked degree, the animal prefers to stand up; 
she lies down but a short time, resting upon the hocks and 
knees, not on the side. The increased pressure in the 
abdominal cavity pushes the diaphragm forward, producing 
dyspnoea. Toward the end of the disease the cow utters an 
expiratory moan. 

Cases have been met with where the distension of the 
belly was so enormous as to produce rupture of the abdominal 
wall and uterine hernia (v. Lindenberg). In rare instances, 
early expulsion of the foetal membranes takes place. 

Diagnosis.—The early recognition of this disease is of the 
ereatest importance, as it leaves some chances for the recovery 
of the mother. Before a diagnosis can be made, an external 
examination of the abdomen, and a rectal, respectively vaginal, 
exploration are necessary. 

Palpation of the right abdominal region for the foetus, and 


138 BOVINE OBSTETRICS 


succussion as practiced in examination for pregnancy, is 
almost always negative. Occasionally we succeed in hearing 
a flushing sound on succussion, but this symptom is also 
observed in ascites. Remembering the lessened resistance of 
the greatly distended abdominal walls, succussion must be 
executed cautiously. Rectal examination detects a constricted 
state of the rectum; that is, the hand is advanced with more 
difficulty than in the normal condition. The enormously 
distended uterus may be palpated on the right when the arm 
is introduced above the elbow. It appears to occupy the 
whole abdominal cavity. The uterus feels like a tense, elastic 
organ of enormous dimensions. Occasionally the calf is 
detected. On exploring the vagina, the os uteri is either 
closed or permits the entrance of one or two fingers. The 
vaginal wall right above the os uteri projects into the lumen af 
the vagina, feeling like a distended bladder lying just above 
the vaginal portion of the uterus (Hess). The increased pres- 
sure in the abdominal cavity pushes the superior vaginal wall 
backward. 

The differential diagnosis is especially directed to distin- 
guish between ascites and hydrallantois. The course, the 
external examination and the rectal exploration are decisive. 

Course and Prognosis.—Hydrailantois always endangers the 
life of the cow. The further pregnancy has advanced, and the 
better the general health of the animal, the greater the hope 
for a favorable termination. There are cases where distention 
of the belly as the result of hydrallantois only manifests itself 
toward the end of the seventh month or beginning of the eighth 
month. Such animals sometimes stand it up to the normal 
time, evacuating a great deal of foetal water at parturition. The 
process of involution of the uterus, while abnormal, usually 
does not lead to fatal terminations. 

In other cases, especially where the accumulation of fluid 
increases rapidly, the symptoms are already noticeable in the 
seventh month. When the cow gets daily bigger, as it is 
termed, a fatal termination may be expected, unless proper 
assistance is rendered. In these animals the dimensions of the 


DROPSY OF THE FHTAL MEMBRANES 139 


belly increase rapidly, respiration becomes difficult, appetite 
and rumination are lessened, the animal becomes a mere 
skeleton and dies unless slaughtered before. Hernia of enor- 
mous size and ruptures of the uterus are also met with. Spon- 
taneous recovery in cows with hydrallantois, so to speak, 
occasionally takes place by abortion. Although the latter 
oceurs but rarely, it is a most favorable termination. 

- Therapeutics.—Therapeutic measures depend on the cause. 
The cause must be removed. We are able to do this by pro- 
ducing artificial abortion. Thus the foetal waters are evacuated 
and the detrimental influences exerted by the greatly distended 
uterus upon the other abdominal viscera cease. In those cases 
where the fingers can enter the cervix uteri, treatment is exceed- 
ingly simple ; the membranes are perforated and waters allowed 
to discharge. After some time labor pains begin and the foetus 
can be expelled or extracted. 

In most cases the finger cannot even enter the os uteri. 
Although it is possible to dilate the cervix uteri (see ‘‘ Partus 
Prematurus Artificialis”), simpler means are at our disposal 
to temporarily relieve the cow, by relieving the intra-abdominal 
tensiou; this may be followed by parturition. This is done 
by puncturing from the right abdominal wall. Cartwright 
originated this method. St. Cyr and Violet, and also Goring, 
do not recommend this method, the former especially advising 
against the use of the trocar and canula. 

I myself have operated in this manner several times in 
hydrallantois, without observing any injurious effects (also 
Leimer and Ymker). Parturition was occasionally retarded, 
which induced me to open the cervix uteri and produce abortion. 

It does not matter how abortion is produced, as long as it 
is done early and carefully, After discharge of the foetal waters, 
labor pains are weak, as the uterus was so greatly distended. 
The calf therefore must be extracted,—by no means always an 
easy task, since the foetus is hard to reach. Whenever neces- 
sary, therefore, the cow is put on her back. 

Too rapid an evacuation of the foetal waters must be 
avoided, as it may produce a collateral cerebral anzemia; the 


149 BOVINE OBSTETRICS 


same is seen in puncturing the rumen when the gas is allowed 
to escape too quickly. The puncture is made in the right 
lower abdominal region under aseptic precautions with Char- 
lier’s trocar. 

After removal of the foetal waters, the skin of the abdomen 
is pushed inward as the canulais withdrawn. One or two days 
later feeble uterine contractions set in, the os uteri opens 
sufficiently to be dilated mechanically and permit extracting 
the foetus. 

The after treatment of such cows is of vital importance. 
It was mentioned previously that the expelling forces are of 
little intensity. Retention of the afterbirth is consequently a 
rule. Measures must be applied to contract the uterus as 
much as possible (Franck, Kammermann). The manual re- 
moval of the foetal envelopes is mostly impossible, but a few 
cotyledons are accessible to the hand. It is best to irrigate 
the uterus once daily with a 2 per cent. alum solution. A 
subcutaneous injection of 6 to 10 g. of ergot (extractum secalis 
cornuti) is often accompanied by excellent results. It is also 
advisable to rub the belly three times daily with spirits of 
camphor. 

Internally, tonics and stimulants, such as the best of food, 
iron, coffee, may be given. 

The process of involution of the uterus is here a prolonged 
one, and the after treatment must endeavor to prevent sequellee ; 
especially from retention of the foetal membranes. 


EIT. 
EXTRA-UTERINE PREGNANCY. 
GRAVIDITAS EXTRA-UTERINA. 


As arule, the foetus develops within the uterus, exception- 
ally outside the uterus; therefore the designation graviditas 
extra-uterina. The impregnated ovum may further develop on 


EXTRA-UTERINE PREGNANCY 141 


the peritoneum, in the ovary and the oviduct. We therefore 
recognize graviditas abdominalis, graviditas ovarialis and gravi- 
ditas tubaria, or salpingocyesis. 

Graviditas abdominalis (abdominal foetation) is the most 
common form of extra-uterine pregnancies. Here the impreg- 
nated ovum is not carried away by the tube, but falls into the 
abdominal cavity. In a previous chapter it was mentioned 
that impregnation of the ovum may occasionally take place in 
the ovaries, provided the Graafian vesicle is ruptured. When 
this ovum is not caught by the fimbriated portion of the Fallopian 
duct, the impregnated egg may develop in the abdominal 
cavity, giving rise to a primary ventral foetation. The annexes 
are formed by the egg, and only the placenta materna is to be 
replaced. It is a fact that a regular placenta replacing the 
placenta materna develops on that part of the peritoneum 
where the impregnated ovum is located. At that spot vessels 
are formed, ce!] proliferation and thickening of the serosa take 
place, resulting in the formation of the placenta, mentioned 
above (Franck). The foetus may mature here, as it is nourished 
from the walls of that neo-formation. In extra-uterine primary 
pregnancy the uterus does not participate any whatever in the 
development of the foetus (Bovy). 

Course.—When the period of gestation is at an end, the 
same changes, only less intense, seen during normal parturition 
take place. The pains are weak, and the cervix uteri is 
dilated but little. Since the uterus does not deviate any from 
a normal state, the contractions of the muscularis are neces- 
sarily weak. The abdominal muscles may assist, and thus pains 
simulating labor pains occur. After this condition has per- 
sisted for several days, pains cease, the foetus dies, and when 
thé air is excluded those changes known as mummification sei 
in. The foetus becomes a lithopedion, possibly remaining for a 
long time without producing any deviations from normal health. 
Very rarely, maceration of the foetus may follow (Hirtle). St. 
Cyr and Violet report a case by Coquet where maceration of 
the foetus was observed. After adhesive inflammation opposite 
the vulva set in, abscess formation and perforation in the 


142 BOVINE OBSTELRICS 


intestinal lumen followed. The bones were expelled with the 
feces. The uterus was empty, its fundus thickened, but with- 
out a cicatrix. 

Symptoms and Diagnosis.—From conception until the end 
of pregnancy nothing abnormal is noticeable in such cows. 
Their general behavior does not differ from a normal pregnant 
state. Graviditas abdominalis is not established with certainty 
during life. An external examination does not reveal anything, 
while rectal or vaginal exploration allows us to surmise this 
abnormality. 

Therapeutics.—In cases where the air is excluded, we may 
wait for mummification, although it is to the interest of our 
client to slaughter the cow. The proper treatment is /aparo- 
tomy, which should not be postponed too long; when operated 
under proper aseptic precautions, this procedure is less formid- 
able than is usually imagined. 

Another form of graviditas abdominalis extra uterina is 
known as secondary fetal pregnancy, in which the first develop- 
ment of the foetus occurred in the uterus. This may follow 
rupture of the uterus. As a consequence, the foetus glides into 
the abdominal cavity and dies, although the possibility exists 
that union with many maternal placentze might be continued 
and the foetus live (Hess). Such a rupture is mostly followed 
by a serious hemorrhage, often causing death of the mother. 

Developments of the foetus in the ovary is termed gravidi- 
tas ovarialis. The causes of this state are still rather obscure. 
Miller describes such a case in a cow; the foetus having reached 
theage of two and one-half months. The specimen is in the 
museum at Vicuna. Ovarian pregnancy is so rare in the cow, 
that, considered from an obstetrical point of view, it only need 
be discussed briefly. The same refers to graviditas tubaria ; 
which so far has not been observed in the cow. 

Franck is of the opinion that complete development of the 
foetus is not possible in the two last named forms, as the wal's 
are not sufficiently elastic, resulting in a rupture. Following 
such a rupture, a secondary abdominal pregnancy, if not death 
from internal hemorrhage, would follow. 


EXTRA-UTERINE PREGNANCY 143 


Veterinary literature mentions a few cases of vaginal preg- 
nancy (graviditas vaginalis), (Deigendesch, Bosetto-Macario, 
Strebel). In these cases it is questionable whether the foetuses, 
already dead when found, developed at all in the vagina. It is 
more reasonable to presume that they came from the uterus 
and remained in the vagina (Franck), and as a result of their 
presence caused disturbances of the vaginal mucosa, resulting 
in a roughened and shaggy state. Strebel describes a case 
where vaginal and uterine pregnancy existed at the same time. 
The foetus lying in the vagina was expelled at the fifth month, 
the other at the normal time. 


D.—ABNORMAL PARTURITION, DYSTOKIA. 


x. 
ABNORMALITIES IN THE MOTHER. 


1.—Displacement of the Pregnant Uterus. 


The normal position of the gravid uterus is in the right 
lower abdominal region. The long axis of the impregnated 
horn and the long axis of the vagina do not form a straight line, 
but an angle. The direction of the long axis of the impreg- 
nated horn deviates toward the right on account of the diagonal 
position of the uterus in the right lower abdominal region. 
The greater the descent of the abdomen, the greater this angle. 
The cause of this physiological deviation is found in the direc- 
tion of the ruamen—from the left flank to the right lower region 
of the ribs. 

Two deviations of great importance in obstetrics are 
observed in the cow: anteversion and torsion. By anteversion 
(which term indicates in the human female a forward flexion of 
the body of the uterus), we understand an abnormal position, 
where the long axis of the impregnated horn forms an angle of 
45 to 90 degrees with the long axis of the pelvis; that is, the 
long axis of the calf forms an open angle with the long axis of 
the mother. 

Anteversion is almost exclusively seen in pendulous bellies, 
but also in hernia uteri in the linea alba or laterally to it. 
Anteversion therefore is accompanied by a very slight rotation 
around the transverse axis. 

In forsio uleri, twisting around the long axis takes place. 
When we imagine the gravid uterus as hanging on the broad 


ligaments, supported by the abdominal walls, then in torsio 
144 


DISPLACEMENT OF THE PREGNANT UTERUS 145 


uteri the superior wall has become the lateral wall, provided a 
quarter revolution took place. 


(A) ANTEVERSIO, OR INFERIOR OBLIQUITY, OF THE UTERUS. 


Descent of the uterus can only take place under certain 
conditions, as in the horizontal posture of the domestic animals 
the right lower abdominal wall supports the uterus and its 
‘contents. 

In man the uterus may be flexed forward or backward 
(anteversion and retroversion). Retroversio uteri does not take 
place in the cow, at least has not yet been observed. 

Atiology.—Anteversio uteri occasionally occurs in the cow 
(here the calf has sunk toward the udder, deviation en bas, 
Rainard). Especially in pendulous bellies, or in old cows 
which calved frequently, a state may occur where the long axis 
of the pregnant horn is almost vertical. Such a deviation may 
be caused by a hernia uteri or tearing of the rectus abdominis 
muscle from the pelvis. 

Van Lent (Holland) reports a case where in an eight-year- 
old cow the right rectus abdominis tore loose from the pelvis. 
This rupture happened six weeks before the end of gestation. 
The belly descended until at last it touched the ground. The 
owner was desirous of waiting for parturition in order to save 
the calf. Birth terminated favorably, although the calf was 
felt to be in an upright position. Some days later the cow was 
killed. 

Symptoms.—This abnormality is of but little moment to 
the mother during the period of gestation. The deviation, 
taking place very gradually, does not interfere with the func- 
tions of any organ; but at birth the expelling powers cannot be 
fully displayed on account of the descent of the uterus, and 
expulsion becomes difficult. The dilatation of the cervix uteri 
is insufficient; the preparatory stage, or the time when this 
takes place, is very much prolonged. When exploring per 
vaginam, the os uteri is found to be sufficiently opened that the 
calf may be reached after practicing a few rotary movements 


146 BOVINE OBSTETRICS 


with the hand. This in due time is generally followed by a 
sufficient dilatation. 

The position of the calf, parallel with the long axis of the 
uterine horn, forms an angle of about 90 degrees with the ex- 
tension of the pelvic axis. In consequence of this, the head 
pushes against the sacrum, while the two forelegs either enter 
the genital canal or are pushed back. 

The preliminary pains may advance the water-bag into the 
vagina ; under those circumstances dilatation is sufficient, but 
the pains may produce an early rupturing of the foetal mem- 
branes, followed by a discharge of the greatest part of the foetal 
water and insufficient dilatation of the cervix uteri. 

The expulsive pains, representing a power acting in the 
direction and against the sacrum, do not expel the calf, but 
gradually weaken until the act of parturition comes to a stand- 
still. 

Therapeutics.—W hen the os uteri is insufficiently dilated and 
the foetal membranes are intact, the hand by rotary movements 
attempts to dilate the cervix uteri. These manipulations 
excite labor pains, by which the water-bag is forced into the 
cervical canal. The latter may be assisted by stroking it with 
the hand and at the same time dilating the cervix with the 
dorsal portion of the hand so that the water-bag enters the 
vagina. For this operation the recumbent position of the cow is 
best; this changes the relationship between the long axis of 
the pregnant cornu and pelvic axis; at the same time the 
abdominal muscle may render assistance. When the foetal 
water has been expelled and the dilatation is insufficient, great 
quantities of warm water ought to be introduced by the use of 
a funnel and rubber tube. The dilatation of the cervix may be 
effected in the same manner, as repeatedly stated. After such 
preparation of the genital passages, extraction of the calf is in 
order. It was previously stated that the expelling powers act 
under such unfavorable circumstances, that parturition is 
impossible. Therapeutics therefore has to fulfil two points : 

1. The long axis of the uterus must be brought on a line 
with the pelvic axis. 


DISPLACEMENT OF THE PREGNANT UTERUS 147 


2. The expelling forces are to be assisted by traction. 

To execute the first, the abdomen of the cow, being in a 
standing posture, is elevated as far as necessary by means of a 
covered board, handled by two assistants. This method, which 
may be modified variously, aids us greatly in the attempts to 
hold the calf. For this purpose a loop is placed around 
the inferior maxilla and also around the forelegs at the 
fetlocks. 

Extraction requires great caution, as undue pulling may 
produce rupture of the uterus. The force exerted by two 
persons having a good foothold suffices for a total extraction. 
Should the calf be in a normal presentation, but its relative or 
absolute size interfere with extraction, embryotomy becomes 
necessary. 

Many obstetricians follow Schaack and place the cow on 
her back, a method of value when the calf is beyond reach. 
This renders the long axis of the pregnant horn almost hori- 
zontal and in line with the pelvic axis. After the foetus has 
been placed into a normal position and head and forelegs fixed, 
extraction may be practiced. 

When extraction takes place in the dorsal position, the 
rather short duration of parturition and the direction in which 
traction is exerted must be considered. The cow does not 
stand the dorsal posture very long, and active traction in this 
position may injure the sacro-iliac articulation. To prevent 
such accidents the head and forelegs of the calf only are fixed 
while the cow is on her back, allowing her to rest on the belly 
afterwards. Both factors—that is, the expelling pains and the 
abdominal muscles—act more forcibly with the cow on her 
abdomen, thus assisting extraction. After-treatment in such 
animals can usually be omitted; the process of involution 
usually takes its course without disturbances. It is advisable 
not to breed such an animal, as this state becomes worse at 
each pregnancy. 

With excessive anteversion, it is possible that during labor 
pains a portion of the uterus in front of the pubis may enter 
into the lumen of the pregnant horn. This inflexion only 


en 


148 BOVINE OBSTETRICS 


occurs when the horn is almost vertical or its anterior portion 
inclined backward. 

After the water-bag has ruptured and uterine contractions 
set in, an inflexion of the inferior uterine wall may possibly 
take place. Exploration of the parts reveals, on entering with 
the hand into the uterus, a fold, which may be so large as to 
almost reach the opposite wall of the uterus. In such a case 
the hand, so to speak, is contained in a sac, through the walls 
of which the calf is felt. Should the fold be less extensive, the 
hand may pass over it into the cavity occupied by the calf. 
It is plain that inflexio uteri is only possible after the cervix 
has been dilated and the foetal water partly escaped. It 
almost exclusively follows a high degree of anteversion. 

Rainard already in 1850 mentions, in his “ Traité complet 
de la Parturition,” that Schaack observed three such cases. 
Our literature is limited in this respect, although a few cases 
have been reported. 

Some years ago I reported a case of inflexio uteri in a cow 
at a meeting of veterinarians. ‘The belly of this animal was so 
greatly distended that the owner supposed it due to twins. 
After laboring half a day unsuccessfully, my assistance was 
requested. On examination I found the os uteri open and a 
small calf in the posterior presentation with its hind legs 
against the abdomen in front of the pelvic inlet After correct- 
ing this position, the calf was extracted by the hind legs. I 
now examined the cow again, for an eventual second calf, and 
detected in the left side a sac through which another foetus 
could be palpated, but I was unable to reach the calf. The 
cow was allowed to rise and led out of the stable to more roomy 
quarters, to diagnose the described conditions and to deliver 
the second calf. Exploration now revealed that the sac had 
disappeared—probably the result of moving the cow—and 
that the water-bag was already in the genital passage. In this 
case the inflexion became corrected spontaneously, and the 
second calf, being in the anterior presentation, was easily born, 

Such cases occur perhaps more frequently than we imagine. 
Small folds do not interfere with extraction, although it is 


DISPLACEMENT OF THR PREGNANT UTERUS 149 


possible that the fold, being as thick again as the uterine wall, 
may become fastened at the pubis during rapid and strong 
extraction, producing rupture. 

The presence of such an inflexion during extraction, pre- 
disposes to rupture of the uterus. 

Treatment consists in elevating the posterior extremities. 
If possible, the cow should be moved about, as exercise usually 
removes the inflexion. 

Schaack advises to put the cow on her back. Rainard 
suggests to raise the abdomen of the cow with a sheet immedi- 
ately in front of the pubis. 

In some cases where the uterus contracts, clasping the calf, 
inflexion cannot be corrected by placing the cow on her back 
and elevating the hind legs. Under such circumstances large 
quantities of warm water are to be introduced into the uterus, 
followed by the above mentioned manipulations. 

Veterinarian Reimers (at Ruinerwold, in Holland) has 
treated, as he told me, twenty cases of inflexion. It is his 
opinion that it can only take place after evacuation of the foetal 
water and cessation of labor pains. On exploration, he could 
only reach the calf when introducing the arm as far as the 
shoulder. An inflexion was found in front and below the pubis, 
and behind it the calf. His treatment consists in elevating 
the cow behind and raising her belly with a covered board at 
the same time. Extraction, as a rule, is easy. 


(B) TORSIO UTERI. 


By torsio uteri is understood a rotation of the uterus 
around its long axis, either to the right or to the left. On 
account of this displacement of the pregnant uterus, expulsion 
of the foetus is impossible, and as a result of circulatory dis- 
turbances both foetus and mother may die. 

History.—Most writers, among others Rainard, Saint Cyr, 
Harms, state that Boutrolle was the first to mention this devia- 
tion in 1766; while not describing it under that name in his 
“Parfait Bouvier,” there can be no doubt that he dealt with a 
torsio uteri. In the works on obstetrics edited after that time,, 


150 BOVINE OBSTETRICS 


torsio uteri is not mentioned until 1829; it seems to have been 
unknown to writers of that period. 

Neither J. G. Eberhard (1793), who studied obstetrics 
under Kersting at Cassel, nor Skellet (1811) and Binz (1830), 
mention torsio uteri, not even under another name. In Rain- 
ard’s work, “ Traité de la Parturition,” the author mentions on 
page 415 that Maurin and Vicillard described torsio uteri in 
1823. 

Prof. A. Numan reported (1831) a post mortem made on 
a sheep in 1829. He thought “that the right pregnant horn of 
the uterus seemed to be connected with the cervix by a twisted 
cord. ‘The broad ligaments, the Fallopian tubes, ovaries and 
the whole left horn of the uterus were wound around this part 
of the uterus, until the whole appeared like a large cord.” 

Irminger and Schenker (1829), Schmid and Vix (1839), 
Rychner in his “ Bujatrik” (1840, page 175), Bleiggenstorfer 
and Schneider (1843), Dénoe (1845), have all described torsio 
uteri. Dénoe and Dieterichs, the latter in the “ Ree. de Med. 
Vet,” 1845, report that German and Swiss veterinarians already 
in 1845 described this torsio uteri, and use the expression 
“torsion du col de Ja matrice.” 

Topographical Anatomy.—The gravid uterus, on account of 
the diagonal position of the rumen, lies in the right lower 
abdominal region. In front it is related to the third and fourth 
stomachs, on the left to the rumen, on the right to the abdo- 
minal wall. The anterior portion is covered by the great 
omentum. The uterus is fixed by the mesometrium, which 
consists of two folds of the peritoneum, descending from the 
sub-lumbar region to the uterus and form its serous layer. In 
the cow, these suspensory ligaments, also known as broad 
ligaments (ligamenta uteri lata), are possessed of anatomical 
peculiarities of importance to the atiology of torsio uteri. 

The broad ligaments are attached to the spinal column of 
the sub-lumbar region and on the parietes of the flanks. On 
reaching the uterus, they envelop it, forming its outer layer or 
serosa. In the cow, the broad ligaments are attached to the 
lateral walls of the uterus, and even a little below them ; so, if 


DISPLACEMENT OF THE PREGNANT UTERUS 15E 


we imagine the uterus suspended by those bands, its greater 
part lies above them. 

Chauveau already in 1848 pointed out this anatomical 
arrangement. The more pregnancy advances, the thicker 
become the broad uterine ligaments. Already in the second 
half of gestation the ligaments are quite muscular, as stripes 
of muscle tissue form in the serosa, as also hypoplasia of the 
elastic and connective tissue. The uterine artery and vein 
anastomosing freely, course in the suspensory ligaments. By 
the contractions of these muscular elements the uterus may be 
elevated. In discussing “ Labor Pains,” it was stated that the 
beginning of each pain represents a contraction of the ligamen- 
tum uteri. 

The mesometrium is not attached all along the lateral 
border of the pregnant horn. The anterior part of the horn, 
which is turned toward the diaphragm, is not fixed by the 
ligaments, but is free. The body of the uterus is attached to 
the vagina by the cervix, the vaginal portion of which lies free 
in the vagina. Although the different organs have a definite 
position in the abdominal cavity, the possibility of a displace- 
ment is not excluded. One deviation was anteversion ; here we 
have to do with a rotation on its long axis. The latter, quite 
frequent in practice, and almost confined to the cow, is quite 
possible on account of the anatomical arrangements just 
described. 

Frequency.—Torsio uteri is usually met with in cows which 
have calved repeatedly, but occasionally a case has been 
observed in primipare (Felder, Buhler). It is a frequent cause 
of dystokia. In the ambulatory clinic at Zurich, of 130 cases of 
dystokia, 29 were torsio uteri, and of these, 16 to the right 
(Ehrhardt). 

Most cases occur during or after the preliminary stage. 
Saake claims that according to his experience torsio uteri is 
never observed before dilatation of the cervix uteri. Mayr, 
Johne, Beel, Felder, Veenstra, Baer, have observed an occas- 
ional torsion during pregnancy in the fifth, sixth, seventh and 
eighth months. In the discussion of mummification, it was 


152 BOVINE OBSTETRICS 


stated that torsion is frequently a cause of it, and that the 
mummy may show the marks of the twisted uterine walls; the 
foetus presenting a spiral depression on its thorax. Torsion at 
the sixth or seventh month often escapes observation and may 
lead to the formation ot a lithopzdion or maceration. This 
must always be remembered when examining a pregnant cow. 

Aitiology.—The malposition of the uterus designated as 
torsio uteri only occurs in the pregnant state. In man, rotation 
of the uterus on its long axis has occasionally been noticed 
during operations. The revolution did not exceed 180 degrees 
and was caused by a tumor (Méschung). Rueff reports an 
‘analogous case in a cow where the uterus rotated in conse- 
quence of an enormous enlargement of the kidney, which 
weighed 15 ke. 

Torsio uteri, it is safe to state, oceurs exclusively in the 
pregnant cow in the second half of the period of gestation, in 
the majority of cases immediately before birth, as we shall see 
later. 

The causes may be divided into two main groups : predis- 
posing and direct causes. The former rest on the anatomical 
arrangement previously described, and on the fact that the 
uterus has sufficient room to rotate, as seen in cows which rise 
on the hind legs first while still on their knees in front. In 
consequence of this oblique posture, the rumen and intestines 
slip forward, giving the uteres more room, and its anterior 
portion, not fixed by the mesometrium, may rotate. It has also 
been observed that in places where the cows stand too closely 
together and therefore are obliged to lie down and get up us 
just described, torsio uteri became more frequent than before 
that time, where each cow had a roomy stall (Franck-Goring). 
The relaxation of the suspensory apparatus of the uterus and 
abdomen has also been brought under this category of causes. 

The direct cause of the rotation must be an active one, and, 
in fact, may exist. 

In discussing the anatomy, the diagonal position of the 
rumen was described. The volume of this organ is very change- 
able. It is true that it occupies a definite position in the 


DISPLACEMENT OF THE PREGNANT UTERUS 153 


abdominal cavity, but its dimensions vary. Many investigators 
are of the opinion that excessive distention of the rumen, as 
observed in tympanites, may induce the rotation. Experience 
at the same time teaches that tympanites may exist without 
causing a torsio uteri in such an animal. Torsio uteri, as 
already stated, may occur at different periods of pregnancy. 
The causes are as yet quite obscure, although they probably 
depend on the same factor which produces torsion at a later 
period, viz., active movements of the foetus. 

From an obstetrical point of view, torsion originating 
immediately before parturition is of most interest. The active 
movements of the calf toward the termination of pregnancy 
may produce changes in the position of the uterus on account 
of the lessened amount of foetal water, especially when the calf 
can brace against the rumen or that part where the rectus 
abdominis muscle is attached beneath the pubis (Mésching). 

The conditions for the production of a torsio uteri are still 
more favorable when the cervix uteri has begun to dilate. At 
that time the uterus has contracted a little and is moulded on 
the calf. Most cases of torsio uteri therefore occur at that 
time, proven by the fact that in many cases found in the litera- 
ture the os uteri was dilated after correction of the malposition, 
and occasionally a living calf was born. 

It appears to happen once in a while that torsion occurs 
when the os uteri is closed, and after correcting the faulty state 
of the uterus, the hand cannot be introduced. Torsion may 
then produce circulatory disturbances, which produce uterine 
contractions—that is, labor pains. On removal of the spiral 
twist, pains cease at once or continue and effect dilatation of 
the cervix and parturition. 

The origin cf a torsion is to be confined in most cases to 
that time when the first pains occur. It is not reasonable that 
a rotation could exist for days or weeks and a live calf be born 
on correcting of such a state. Under such conditions there must 
be circulatory disturbances which endanger the life of the 
foetus and produce pains, ora torsion of long standing would 
lead to such changes that a reposition becomes impossible. 


154 BOVINE OBSTETRICS 


Direction and Degree of Torsion—Rotation of the gravid 
uterus on its long axis may be to the right or left. Revoluticus 
to the right predominate. By twisting from left to right, or, 
simply, right torsion, we understand a change in the position 
of the uterus, where the superior wall becomes the lateral wall 
and finally the inferior wall of the uterus. Left torsion repre- 
sents the reverse movement. (Harms, Franck and others.) 

When the upper wall has become the right lateral wall, it 
is a torsion of 90 degrees, or quarter torsion. Should the 
upper wall continue to rotate from here (right side), so that it 
becomes the lower wall, it is termed a torsion of 180 degrees, 
or half torsion. When now the upper wall of the uterus con- 
tinues to revolve, until it reaches the left abdominal region of 
the cow—that is, becomes the left lateral wall of the uterus— 
the torsion is one of 270 degrees, or three-quarter torsion, to 
the right. After the upper wall has made these rotations to 
the right successively, and again regains its original position— 
that is, becomes the upper uterine wall once more—a torsion 
of 360 degrees, or a complete rotation to the right, has taken 
place. A torsion beyond 270 degrees will rarely occur, as it 
exceeds the limit of elasticity of the broad uterine ligaments, 
followed possibly by rupture. In the majority of cases result- 
ing in complete recovery after untwisting the uterus, torsion at 
the utmost amounted to 860 degrees. 

Rotation of the uterus renders the broad ligaments tense. 
Any revolution beyond 90 degrees contracts the cervix uteri. 

Although the possibility cannot be denied that a revolu- 
tion of the uterus itself may occur without involving the vagina, 
such cases must be rare. The vagina mostly rotates at the 
same time; on exploration per vaginam, spirals or cords the 
result of torsion are felt. 

Circulatory disturbances in the vascular territory of the 
uterus may arise as a result of torsion; but they are limited 
when rotation does not exceed 90 degrees. The veins, on 
account of their thin walls, are the first to be unfavorably 
influenced; their lumen decreases and the return flow of the 
blood is interfered with. Since the uterine circulation is very 


DISPLACEMENT OF THE PREGNANT UTERUS 155 


happily arranged on account of the enormous collateral 
branches in the broad ligaments, the influx and return flow of 
the blood is handicapped but little in a quarter torsion. This 
is quite different when the rotation reaches 180 degrees or 
more. Now disturbances follow, not equalized by collateral 
circulation. Venous stasis arises, and, in consequence of an 
excess of carbon in the uterine blood, contractions (labor pains), 
indicated by lively movements of the foetus at an early period, 
set in. A torsion of 270 degrees or 380 degrees, persisting for 
some time, prevents placental circulation and causes death of 
the foetus. 

The above discussions are based upon a rotation of the 
uterus on its long axis. 

Ehrhardt presents this opinion: “ Rotation of the uterus 
takes place on its vertical axis, and therefore it would be better 
to speak of a versio uteri. At the moment of quarter torsion 
the foetus occupies a transverse position. When the foetus les 
in a normal presentation, with the anterior portion of the body 
toward the pelvic inlet, then its head is in the direction of the 
right abdominal wall of the cow in quarter torsion.” 

Ehrhardt and Franck believe that most torsions of the 
uterus take place at an earlier period of pregnancy, although 
he admits that two factors are necessary for its production : 1. 
The uterus must have descended into the abdominal cavity. 
2. The foetus must be sufficiently matured to produce rotation 
by its movements. 

Moésching published a very interesting contribution on 
torsio uteri in the cow. We learn from his report, referring to 
121 cows and one goat, that torsion occurred 88 times to the 
right and 34 times to the left. The termination was favorable 
in 94 instances, and mostly without complications. 

Symptoms.—The symptoms of rotation of the uterus from 
the middle of pregnancy until the eighth month are often not 
recognized as such. Usually the diagnosis is colic. The cow 
kicks the hind legs against the belly, gets up and down and 1s 
very restless. The phenomena last about one day, when 
appetite diminishes, rumination may even cease, defecation is 


156 BOVINE OBSTETRICS 


retarded, the fseces are more consistent than ordinarily, slight 
tympanitis is present. An observing attendant possibly notices 
straining, attributing it to attempts to pass the hardened 
manure. Torsion occurring in the fourth or fifth menth is not 
followed by any other symptoms. Two or three days later the 
animal improves, begins to eat and ruminates and appears 
well. The whole process is even occasionally diagnosed by the 
professional man on superficial examination as indigestion and 
treated accordingly. 

The rectal examination, which must never be omitted in a 
pregnant animal showing such symptoms, may at once explain 
such symptoms. On exploration, we detect the spirals of the 
twisted cervix uteri. A vaginal examination following it 
establishes the degree and direction of torsion. When preg- 
nancy is more advanced, labor pains accompany the above 
named phenomena. These pains are the result of venous stasis 
in the uterus following torsion. These symptoms, quite per- 
sistent, as well as the uterine contractions assisted by the 
abdominal muscles, lead us to think of parturition. This 
ensemble furnishes a picture of torsio uteri immediately before 
parturition, so frequently seen, and therefore of great import- 
ance to obstetrics. 

Symptoms of torsio uteri at the time of parturition.—Any body 
who has met torsio uteri frequently in practice recognizes this 
condition in a cow by the history of the case. The attendant 
usually reports as follows: 

“The time the cow should calve has come or passed by 
several days. Yesterday or the day before yesterday, I thought 
she was going to have a calf, as I saw symptoms, observed in 
the preliminary stage. The cow paddled behind, got up and 
down frequently, strained, rested a while and started anew, so 
that I expected her to find a calf at every moment. As yet 
nothing has shown itself, no water-bag, no fetal water. I 
believe that something is wrong.” 

The owner usually does not know whether the calf is still 
alive or dead. The examination reveals the following: The 
cow stands quietly, the udder is filled, the ligaments are either 


DISPLACEMENT OF THE PREGNANT UTERUS 157 
partly or entirely sunk in; now and then pains, followed by 
long intervals of rest, are manifested. When called early the 
pains are quite intense, then later where the uterus has become 
atonic.. After the necessary preparations are made, examina- 
tion per vagina is practiced. In some cows we notice that the 
superior commissure of the vulva has retracted. On introduc- 
ing the hand into the vagina, we feel, after passing the vesti- 
bule, that the further advance of the hand up to the os uteri is 
difficult. Under normal conditions the vagina is wide and the 
hand can be spread in it, especially in cows which have calved 
repeatedly. This is impossible in torsions. The vagina is 
twisted like a screw. In order to advance with the hand 
between the folds by allowing the fingers to follow the spirals 
the dorsal surface of the hand must be rotated until it becomes 
the lower surface of the hand, or, in other words, the palm is 
uppermost. 

When a right torsion is examined by the right hand, the 
folds run from the superior wall of the vagina from left to right 
and obliquely forward and downward, or while the right hand 
is introduced in a state of pronation [palm downwards, W.] it 
arrives, when following the cords, at a state of supination 
[palm upwards, W.]. I use here the term “ cords,” as it comes 
closest to reality. 

Saake very properly says that the expression, “spiral 
twists of the vagina and cervix uteri,’ is besed more upon a 
subjective interpretation than objective observation. 

In a right torsion of 180 degrees, two cords crossing each 
other are felt in front of the os uteri, the upper one running 
postero-anteriorly from left to right. In half torsion, the hand 
following the cords reaches the os uteri and usually enters the 
uterus. In rotations of more than 190 degrees, the cervix uteri 
cannot be reached any more; only in old cows with flabby, 
broad ligaments we may occasionally succeed. 

The constriction of the cervix uteri, leading to the forma- 
tion of those cords, is caused by the broad uterine ligaments. 
At half torsion both are rendered tense, allowing us to feel two 
cords on vaginal exploration. Quarter rotation only reveals one 


158 BOVINE OBSTETRICS 


cord, as only the broad ligament of that side toward which 
rotation occurred is tightened. In order to make a diagnosis 
the standing posture of the cow is preferable ; but, should we 
only wish to enter the uterus, the recumbent position of the 
cow is of advantage. In right torsion the animal is placed on 
the right side and the right hand employed in exploration. 

[The following rule might be remembered: When the 
dorsal surface of the hand turns to the right, the torsion is 
to the right, or vice versa.—W. | 

In consequence of the constriction and tension of the 
broad uterine ligaments, the flow of blood in the uterine artery 
is obstructed and should be followed by increased pulsations. 
The artery of that ligament which is tensest should therefore 
pulsate more strongly ; thus, in right torsion, the right uterine 
artery ; in left torsion, the left artery (Meyer.) Theoretically 
this is correct and would be an excellent diagnostic point to 
define the direction of the torsion. In practice, however, while 
feeling pulsations through the vaginal wall, it is only too often 
difficult to recognize whether the pulsations come from the 
uterine artery or not. Nevertheless, a strong pulsation or 
throbbing (Schmidt) on one side may lead us to surmise that 
the rotation occurred in that direction. This, together with 
direction of the cords, may complete the diagnosis. 

The latter phenomenon is absent ina torsion of long stand- 
ing. It is only met with in recent cases and in that respect 
may be a prognostic symptom of the greatest importance. 

Course.—It happens occasionally that torsion is corrected 
spontaneously (Moésching). This rare termination may take 
place in rotations of 90 degrees, or, at the utmost, 180 degrees, 
occurring in the preliminary stage. Factors favorable to this 
spontaneous correction are: elevation of the hind parts, thus 
giving the pregnant uterus more room; and active foetal move- 
ments. A rotation of 90 degrees may also be corrected by 
rupture of the water-bag, followed by partial evacuation of the 
foetal water and consequently room for retorsion (Goring). 

Torsion of 90 degrees creates but little circulatory dis- 
turbance ; which is soon compensated by collateral circulation, 


DISPLACEMENT OF THE PREGNANT UTERUS 159 


so that the primary uterine contractions soon cease, and should 
the end of gestation not yet be reached, a quarter torsion may 
exist some time without endangering foetal life. Rotations of 
180 degrees give rise to circulatory troubles, followed by 
asphyxia and death of the foetus unless torsion is remedied in 
time. 

The blood in the placentze becomes laden with carbon 
dioxide when venous return flow is interfered with. By it the 
nerve-centres of the uterus become irritated and pains set in. 
When this torsion is relieved by proper treatment, the cause of 
the pains is removed and gestation may run its normal course 
(Felder, Baer). Abortion often follows. 

Felder describes a case where torsion in the thirty-fourth 
week of pregnancy was removed by rolling the cow, followed 
by birth of a living calf in five and one-half weeks. 

In torsion of 180 degrees or over, where the normal con- 
dition is not established, pains cease in two or three days; the 
uterus is exhausted ; appetite, unless previously diminished, is 
absent, and symptoms of peritonitis are noticeable. The calf 
mummifies, as air is excluded. Should many manipulations 
have been practiced to effect detorsion, so that the foetal 
envelopes are ruptured, the foetal waters partly escaped and air 
enters the uterine cavity, decomposition of the calf sets in and 
it becomes emphysematous. In consequence of this, septic 
metritis and metro-peritonitis, as diffuse phlegmonous states, 
with fatal termination within six to ten days, setin. A high 
degree of torsion often terminates in rupture of the broad 
uterine ligaments or rupture of the uterus. As a consequence 
of a hemorrhage, which often follows, death may occur within 
a very few hours. 

When air is absolutely excluded in torsions of 180 degrees 
or more, a chronic peritonitis may set in, inducing adhesions 
of the uterus and adjoining organs. 

Pathological Anatomy.—Post mortem examination made on 
a cow, which died as a result of torsio uteri, reveals the morbid 
changes of a peritonitis and the malposition of the uterus. 
The former may have had an acute course—that is, of the 


160 BOVINE OBSTETRICS 


character of aseptic peritonitis—or a subacute one, with 
exudations between the folds of the uterus first; next, for- 
mation of young connective tissue, leading finally to adhesions. 
In the former, decomposition of the foetus and its distention by 
gas formation are common. In subacute peritonitis the calf is 
often not decomposed. 

In the abdominal cavity an exudate, either sero-hzemor- 
rhagic or sero-fibrinous, is always found. 

When septic peritonitis leads to septicaemia, the cadaver 
soon decomposes, and besides the symptoms due to dissolution 
of the blood, enteritis and pleuritis are present. 

In rupture of the uterus the lower wall of the cervix uteri 
is usually torn off and a part of the foetal waters mixed with a 
great deal of blood are contained in the abdominal cavity. 
Occasionally the calf is found within the latter. 

Prognosis.—A torsion, occurring toward the end of gesta- 
tion, must be judged as to its degree and length of time during 
which it existed. Torsions up to 180 degrees are more favor- 
able than those exceeding it. A living calf is a favorable indi- 
cation for a happy termination. A torsion of two or three days’ 
standing, where the owner and others have made repeated 
explorations, should be prognosed unfavorably. 

Although experience teaches that the termination is usually 
more favorable than imagined (of 121 cases in Moésching’s 
statistics, 94 were corrected), a careful prognosis nevertheless 
is indicated. 

Torsio uteri does not seem to predispose an animal to the 
same condition in future pregnancies. 

Therapeutics.—The treatment endeavors to remove the 
torsion. Many methods are employed. Every practitioner 
prefers the one giving him the best results, and justly so. 
Any thinking man must admit that a standard method is 
not applicable to every torsion, and when one is unsuc- 
cessful, another one should be practiced. In fact, every case 
must be criticized separately and that treatment employed 
which is apt to yield the best results in the case under con- 
sideration. I discuss the treatment here under two heads; 


DISPLACEMENT OF THE PREGNANT UTERUS 161 


First, the preparation; and secondly, the removal of the 
abnormal position. 

Preparations.—¥ or the experienced practitioner this enum- 
eration is superfluous ; he knows the difficulties under which 
the obstetrician labors, and he considers anything which will 
be of assistance or disadvantage to him. But for the sake of 
the beginner, not yet experienced, I shall discuss those points 
more fully. 

In crowded stables, with little space behind the cow, a 
proper examination cannot be made. Some owners (especially 
the small breeder) often raise objections to move a cow well 
advanced in pregnancy, and prefer to have the veterinarian ex- 
amine her then and there. The veterinarian, to avoid difficul- 
ties, submits to the wishes of the owner, and examination and 
treatment begin under adverse circumstances. Should this be 
followed by an unfavorable termination, he can hardly fall back 
on the objections raised by the owner, as the case should have 
been treated by the attending surgeon according to the rules of 
the veterinarian. Therefore, the first condition is szfficient 
room. No attention should be paid to such remarks as, “ It is 
impossible ; the cow might catch cold,” ete., but tell the owner 
that a thorough examination is to his own interest and that 
treatment under favorable circumstances has a great tendency 
to bring with it good results. While at first a little provoked, 
he is apt to appreciate later the firm stand of the veterinarian, 
which after all enhances his reputation and standing and is 
much better than yielding concessions which interfere with the 
proper execution of the operation. Ample room is requisite, as 
we shall see, both to roll the animal and to execute other 
methods. 

After washing and cleansing the vulva, tail and neighbor- 
ing parts, and also washing and oiling the arm of the obstetri- 
cian, the examination is started, on the results of which the 
method to be applied depends. 

Repeated explorations, rough palpation, are out of place, 
but a calm, careful local examination is practiced, at the same 
time interpreting the discoveries made by the hand, combining 


162 BOVINE OBSTETRICS 


them with the history of the case. Next the treatment proper 
begins. 

The correction of the abnormal position may be done in two 
ways : 

1. By rotation of the cow after previously fixing the calf 
and uterus. 2. By rotation of the uterus and calf. 

The latter may be done from (a) the vagina; (b) by detor- 
sion after laparotomy. 

No matter which method is employed, we must always 
remember that elevation of the posterior extremities greatly 
assists in the removal of such an abnormal condition. While 
speaking of spontaneous retorsion it was mentioned that the 
evacuation of the foetal water may have a favorable effect. 
Therefore, whenever possible, the foetal envelopes should be 
ruptured by hand. By reducing the volume of the uterus, 
room is gained and retorsion may become easier. 


J.—ROTATION OF THE COW. 


The purpose of this method consists in placing the uterus 
in a normal position, by rotating the mother in the direction of 
the torsio uteri. Thus, in right torsio uteri, the cow is rolled 
over to the right. In many cases the uterus rotates at the 
same time, making retorsion impossible. Only when uterus 
and calf remain stationary can torsio uteri be remedied by 
rotating the mother on her long axis. 

Rotation of the cow is executed as follows: In right torsio 
uteri the cow is placed upon the right side, or we wait until 
she does so herself. Should she retain the standing posture 
too long, she may be thrown carefully. ‘The fore legs and hind 
legs are secured, but not all four feet tied in a bunch. After 
elevating the hind quarters by pushing bundles of straw under 
it, rotation may begin. The bundles of straw are best made by 
laying one-half of the straw with their heads one way and the 
other half in the opposite direction, in order to secure a bundle 
of uniform thickness. Each bundle is tied up with three ropes 
to prevent the cow from gliding off it, which occurs when 
ordinary bundles of straw are used, 


DISPLACEMENT OF THE PREGNANT UTEKUS 163 


While some assistants roll the cow from the right side 
upon her back, the obstetrician introduces the clean, well oiled 
hand into the vagina and attempts to follow the folds as far as 
possible. 

In torsion of 90 degrees to 180 degrees he even succeeds 
in entering the uterus, and the possibility exists to fix some 
part of the calf and in this way retain the uterus and calf while 
the assistants roll the cow. After the cow is rolled on her 
back she is rotated until lying upon the left side. The obliter- 
ation of the spirals is immediately perceived by the hand in the 
vagina, provided retorsion is successful. In quarter and half 
torsion this rotation is mostly sufficient, especially when the 
cervix uteri is open and the hand can be advanced and hold 
the calf in position. 

In order to assist the obstetrician in the attempts to fix 
uterus and calf, pressure should be exerted upon the calf along 
the flank. 

Torsions of 360 degrees or more do not allow the hand to 
enter the uterus or fix the calf. Felder, in such cases, tries to 
get hold of the foetus through the wall of the vagina, he look- 
ing upon this as the vital point in rotating the mother. When- 
ever this method is practiced great care is required, as the 
uterus may be ruptured. 

When the calf and uterus rotate with the cow—frequently 
the case in large calves—rotation in the same direction must 
be repeated, while the exploring hand attempts to reach the 
uterus. 

In some descriptions repeated rotations of the cow are 
spoken of; for instance, from the right side, over the back, 
onto the left side, over the belly, again to the right side, etc. 
In fact, we may achieve our purpose in this manner. At the 
same time I believe that such continuous rotations ought only 
to be practiced when the hand cannot enter into the uterus. 

I succeeded several times in correcting a half torsion as fol- 
lows: In half torsion to the right I place the cow upon the left 
side, and permit the hand to follow the spirals into the uterus. 
After tying the fore and hind legs separately, the cow is rolled 


164 BOVINE OBSTETRICS 


on her back. As a rule, calf and uterus rotate at the same 
time. Now I endeavor to render the calf immovable; the cow 
is quickly rolled back onto the left side and allowed to rise. 
Tn some cases detorsion is obtained provided the hindquarters 
are well elevated. 

Any doubts regarding the direction of the torsion are 
easily dispelled by rolling the cow. When the vaginal constric- 
tion increases or decreases by rotation, the rolling in the first 
instance is in the wrong direction and in the latter in the right 
direction. Beginners may in this manner confirm their diag- 
nosis. 

For this purpose the cow is placed upon the right side, the 
fore and hind legs tied separately, the posterior extremities 
being raised. The right hand in the vagina follows the folds, 
while the cow is rolled on her back and then slowly on the left 
side. Any increased pressure upon the hand and arm after 
such a rotation shows at once that the cow is rolled in the 
wrong direction and that rotation is to be practiced in the 
opposite direction. 

Guillod states that the obstetrician should roll over instead 
of the cow. By following the spirals with the hand and roll- 
ing from the abdomen upon the back, the uterus may be 
entered. His method was effective in ten cases where he 
rotated the cow in vain. 

Rotation of the cow is one of the oldest methods and was 
mentioned already by Rychner in his “ Bujatrik.” 

Another method of treatment consists in rotation of the 
uterus and calf. The cow may be left in the standing or recum- 
bent posture. In this method detorsion is either practiced 
from the vagina or uterus, or by first performing laparotomy. 


DETORSION FROM THE VAGINA AND UTERUS. 


This method has many advantages over rotation of the 
mother. It may be executed in two ways: in the standing and 
recumbent position of the animal. But I wish to emphasize 
the fact, that this method can only be successful when the hand 
can enter the uterus; that is, in torsions of 90 degrees to 180 


DISPLACEMENT OF THE PREGNANT UTERUS 165 


degrees, when the cervix uteri is dilated, or, in other words, in 
torsions originated in the preliminary stage of parturition. 

When this method is to be practiced in the recumbent 
position, the cow is placed on her back and the hindquarters 
are raised. While following with the hand the spirals in the 
vagina, one endeavors to enter the uterus and to get hold of the 
head, or, in a posterior presentation, the hind legs. After 
rupturing the envelopes and partial evacuation of the foetal 
water, we grasp in aright torsion the head or legs of the calf 
and push them to the left and upward. 

Should the hand succeed in entering the uterus sufficiently 
far to reach the shoulder of the calf, it should be placed against 
it and pressure exerted to the left and upward. In most cases 
we notice that this displacement is followed by a decrease of 
pressure upon the arm, and on retraction of the arm sufficient 
space is present to draw the fore legs or head into the genital 
passage. 

Should torsion persist after the hand is withdrawn, it 
frequently recovers spontaneously, as soon as the head is 
driven into the pelvic inlet. 

Darreau manufactured an instrument which he called 
“rétroverseur uterin.” It consists of three rods, three cords, 
a winch and screw. By means of it the head and fore legs of 
the calf are secured and counter-torsion attempted. The in- 
strument shall replace the hand. I believe that in cases where 
the head and fore legs of the calf can be reached, just as good 
results are obtained by any of the other procedures. 

Retroversion in the standing animal has found many 
admirers lately on account of its simplicity and success. 
According to P. Knusel, forty years ago the veterinarians J. 
and B. Kamer, in Arth and Kissnacht (Canton Schwyz), 
applied this method. 

As previously stated, this method is only applicable when 
parts of the calf are within reach of the hand in the uterus. 

The larger the calf, the more the uterus descends, the 
greater its execution. Knisel reports a successful detorsion. 
from the vagina in 80 per cent. of all cases. 


166 BOVINE OBSTETRICS 


Procedure.—The cow is elevated behind, or if convenient 
the ground may be removed in front of her, so that the floor 
is lower in front than behind. While following with the hand 
along the folds an attempt is made to get into the uterus, 
envelopes are ruptured and the hand is rested against the neck 
or shoulder of the calf. While pushing the calf in a direction 
opposite to which torsion took place, the abnormal position 
may be removed. For this purpose the calf should be pushed 
as much as possible against the opposite wall of the uterus. 
Retroversion by means of the hand and arm from the vagina 
and uterus in the cow is a method which has been tested by 
many veterinarians, and can be recommended on account of its 
good results (Knisel, Felder, Ehrhardt, Buhler, Holder). At 
the same time it calls for considerable force and some practice. 
In torsions of 90 degrees to 180 degrees this method is prefer- 
able to others. 

The reposition by means of the hand from the vagina may, 
when necessary, be combined with rotation of the mother. 
Many variations may be tried, but it must always be observed 
that the hind parts are raised, as it assists greatly in detorsion. 
The favorable results of retroversion in the standing posture 
with elevation of the posterior extremities must be mainly 
attributed to this circumstance. 

Goring described a very advantageous procedure, but only 
applicable to those torsions where the hand can be introduced 
into the uterus. He places the mother into a dorsal position. 
While he tries to enter the uterus by following the spirals the 
animal is rolled to the right and left in order to detect in which 
direction the hand progresses best. That position giving best 
results is finally retained. After the foetal membranes are 
ruptured, the foetal water evacuated, he draws one or both legs 
into the vagina. These are secured with loops and returned 
into the uterus. Now the head is brought into the genital 
canal, the lower jaw is looped or fixed by hooking an eye. ‘Two 
men now draw the head gently into the spirals, leaving it here 
five to six minutes. He next brings the previously looped legs 
into the vagina, first one and then the other. After head and 


DISPLACEMENT OF THE PREGNANT UTERUS 167 


fore legs have entered the pelvis, traction is alternately exerted 
upon the fore legs until they are extended, and parturition is 
completed by a few vigorous pulls on all ropes. 

This method of extraction, as practiced by Géring, must be 
executed carefully, and severe traction is to be avoided. Some 
practitioners will not practice any traction until detorsion takes 
place, in order to avoid injuries (Saake). 

Albert puts the cow into the dorsal position, pulls her up 
by the hind legs about two and one-half feet and supports the 
back and sacrum with bundles of straw. In consequence of the 
elevated position of the posterior extremities the uterus gains 
a good deal of room and the hand often advances further. By 
exerting pressure from without upon the calf and in a direction 
opposite to the torsion, retorsion may be effected. 


RETROVERSION FOLLOWING LAPARATOMY. 


This method can only be employed when all other methods 
fail. A small percentage therefore remains for this operation, 
the results of which are not too encouraging, to judge by 
reports (St. Cyr and Violet). No wonder, as this operation 
usually follows varied manipulations and often brutal interfer- 
ence. In most cases the owner has already the intention to 
slaughter the animal and finally permits the operation, on con- 
dition to kill the animal as soon as fatal symptoms manifest 
themselves. 

The purpose of this procedure is to return the uterus and 
ealf into a normal position from within the abdominal cavity. 
It consists of a bloody operation (laparotomy) and in retrover- 
sion. The field of operation is in the right flank. Although’ 
the upper region of the flank, in consideration of future healing 
of the wound, would be the most favorable site, as here a hernia 
is less liable to occur, retroversion is exceedingly difficult at 
that part, so that it is better to incise further down. With 
regard to the execution of the operation I refer to page 215. 

The wound in the abdominal wall, having a length of 20 
em., should run obliquely downward and forward in the diree- 
tion of the fibres of the internal oblique muscle. 


168 BOVINE OBSTELRICS 


After the incision has been made the operator enters with 
the carefully cleansed arm into the abdominal cavity, acquaints 
himself with the direction of the torsion and whether ruptures 
are present or not. This examination must be made exceed- 
ingly carefully, to avoid being accused of producing injuries 
already existing. 

In right torsion the right hand of the operator penetrates 
between the uterus and lower right abdominal wall and attempts 
to reach beneath the uterus the linea alba, or, if possible, the 
left side of the uterus. When successful he grasps there a leg 
of the calf and the uterus, pulling it gradually in his direction, 
at the same time raising the uterus. These manipulations are 
materially aided when an assistant at the same time presses 
against the left lower abdominal region, or when the belly is 
raised by means of a board (Franck). In left torsion, the hand 
is allowed to glide over the upper face of the uterns to the left 
side as deeply as possible ; there parts of the calf and uterus 
are secured and thrown toward the operator. 

A well instructed assistant, whose hand is in the vagina 
during the operation, can feel immediately when retroversion is 
successful, as his hand can then pass by the spiral folds. He 
may also assist in further retroversion. 

Retroversion from within the abdominal cavity is a hereu- 
lean task, and it is not always possible to twist a weight of 
occasionally 70 to 80 kg. with one hand; at the same time as 
much as possible of the uterus and calf must be raised in order 
to pull on it carefully (Franck). 

Prognosis.—When the operation takes place on the second 
day and the genital passages have not been injured by rough or 
unskilled aid, this method may be successful; but when the 
owner waits three or four days and symptoms of peritonitis are 
noticeable, prognosis is exceedingly unfavorable, especially 
when after laparotomy a greatly distended uterus from an 
emphysematous foetus is revealed. Such cases are fatal. 

Retroversion after laparotomy is a very good method and 
successful in many instances when the operation and reduction 
occur in time and no disturbances exist from previously applied 


DISPLACEMENT OF THE PREGNANT UTERUS 169 


methods. There is no reason to fear peritonitis provided the 
operation is artfully performed ; reduction also is not always 
as difficult as one may think. Franck, Goring, advise to make 
a close examination of the genital passage, before operating, in 
order to convince ourselves whether the animal has been 
abused previously or not. This is excellent advice and may 
save the veterinarian disagreeable moments, as the owner may 
later blame the operation for any accident which might follow 
it. 

After completing retroversion, the abdominal wound is 
stitched and treated, as discussed further on. Explorations to 
see whether parturition is possible should immediately follow 
the closing of the wound, and as a rule the hand can enter the 
uterus and reach the calf. Parturition ought to be brought to 
a close as soon as possible, but without too much traction, 
remembering eventual injuries which might have occurred 
during retroversion. 

Whether the os uteri is open or closed after retroversion 
depends on the time during which torsion took place. In 
torsion occurring at the time the cervix uteri dilated, the os 
uteri is almost wide open after detorsion. Pains and the 
mechanical action of the water-bag then take care of complete 
dilatation, so that parturition may be done successfully. This 
is the usual course in practice. 

When torsion occurs a few days before the end of gestation 
—that is, with a closed os uteri—pains, the consequence of a 
disturbed circulation, manifest themselves. After reducing the 
abnormal position, the os uteri is found impervious. Now two 
possibilities exist: The pains cease, as the cause, the dis- 
turbed circulation, has been corrected, and in due time normal 
birth follows, or the pains continue and the cervix uteri opens 
after a while in the ordinary manner. 

Felder reports two cases of the first kind. The one 
happened in a cow where torsion was corrected by rolling the 
animal and fixing the calf through the vaginal walls. Five 
weeks and a half later she gave birth toa healthy calf, enjoying 
good health during all that time. 





170 BOVINE OBSTETRICS 


In the other case of torsio uteri, the hand could only be 
passed into the uterus with difficulty. After successful retro- 
version, nature was allowed to take its course. Fourteen hours 
later parturition took place without any special aid. 

How shall we proceed, when the os uteri is still closed 
after detorsion ? 

When the ligaments are sunk in, and the udder full, so that 
everything points to an early parturition, we should not be in 
too great a hurry to forcibly dilate the os uteri. Cautious 
dilatation by rotary movements with the finger do no harm. 
Incisions are to be avoided uuless the os uteri is obliterated, 
As regards the latter, lrefer to page . It is much better to 
modify the excessive activity of the abdominal muscles by 
giving chloral hydrate per os or per rectam; the latter is 
preferable. 

Another examination made in a few hours usually detects 
some dilatation. As long as the calf lives, we may wait for a 
sufficient dilatation. 

In cases where dilatation of the cervix uteri succeeds re- 
troversion, aud the water-bag can be felt with the finger, nature 
is permitted to take its course, and assistance rendered where 
necessary. 

When torsion has existed for some days or longer and the 
foetus is dead, insufficient dilatation of the cervix often follows 
retroversion. Should the pains be feeble and the foetal water 
partly evacuated, the immediate mechanical dilatation of the 
cervix uteri becomes a necessity (see page 


2.—Abnormalities in the Parturient Passages. 


As: pelvic constrictions, morbid alterations in the cervix 
uteri, abnormalities of the vagina and vulva. 


PELVIC CONSTRICTION. 


While discussing pelvimetry it was stated that the normal 
dimensions of the pelvic inlet and passage are definite in char- 
acter ; it was further remarked that the dimensions of the foetus 


ABNORMALITIES IN THE PARTURIENT PASSAGES IGP Git 


must correspond with the diameters of the pelvis, in order to 
have natural parturition. A pelvic constriction, quite fre- 
quently observed in practice, is found in the juvenile pelvis. 

It is oceasionally met with in two-year-old heifers, in 
primipare ; that is, at an age when they bear young the first 
time. This pelvis is laterally constricted, especially in the 
lower half. Relations between the transverse and vertical 
diameter of the pelvic inlet may be normal, but the distance 
between the pectineal tubercles, and especially between 
the two cotyloid cavities, is lessened. As a consequence the 
pelvic canal is narrow and renders the passage of the calf 
difficult. 

Symptoms and Prognosis.—In this pelvic constriction, the 
head, resting on the fore legs, passes the pelvic inlet, but the 
withers and shoulders do not enter the pelvis. Parturition has 
advanced to that point where the head and fore legs, the latter 
slightly retracted, are visible at the vulva. Should the act of 
birth have lasted already several hours, the foetus is mostly 
dead and the swollen tongue protrudes from the mouth. The 
attendant, as a rule, has practiced extraction unsuccessfully and 
the veterinarian on arrival finds head and legs firmly wedged 
in the pelvis. 

The calf in itself may be of normal size, but is relatively 
’ too large for the pelvic dimensions of the mother. 

The prognosis as regards the calf is unfavorable. It is 
rare to see the calf live after extraction, provided it can be 
removed as a whole. 

With regard to the mother, the prognosis is more favor- 
able, unless the attendant exerted powerful traction. It can be 
said that in general such a heifer stands a forcible extraction 
astonishingly well. 

At this age the pelvis is not yet completely ossified, being 
slightly dilatable. Stretching of the symphysis at that age in 
the heifer is more quickly repaired than in the adult or old cow. 
Many owners, who never permit severe traction on the calf, 
base their experience on the extraction of a calf in a young cow 
by five or six men. The juvenile pelvis does not interfere with 


172 BOVINE OBSTETRICS 


future parturitions. The relative dimensions of the bovine 
pelvis already at an age of three years possess much more 
favorable proportion for birth, when nutritious food rich in 
lime salts has been fed. 

Therapeutics.—It is desirable to prepare as much as pos- 
sible the dilatation of the parturient passages, so matters may 
not be made worse by disturbances of the soft parts, as, for 
instance, insufficient opening of the cervix uteri. The amount 
of traction which may be applied must not exceed the force 
developed by three men at the utmost. In an anterior position, 
with the head resting upon the fore legs, alternate traction may 
be exerted upon them to get the shoulders out of the way and 
thus decrease the bicostal diameter. When half of the calf is 
born, its trochanteric diameter is rendered parallel with the 
vertical diameter of the pelvis, by rotating the calf on its side. 
On a posterior presentation, with the hind legs in the genital 
passage, the trochanteric diameter of the calf is made to enter 
the pelvic inlet obliquely, its passage being assisted by alter- 
uately pulling on the hind legs, thus decreasing the distance 
between the calf’s trochanters. See also page 186. 

Unilateral or bilateral depression of the sacrum causes nar- 
rowness of the pelvie cavity. Stockfleth describes a case where 
the displaced wings of the sacrum and the posterior iliac spine 
had become united by strong connective tissue. In bilateral 
depression or complete sacro-iliac laxation, the height and 
width of the pelvic inlet decrease. Au irregular callus follow- 
ing a fracture may also lessen pelvic dimensions. The most 
important fractures are: Fracture of the internal angle of the 
ilium and subsequent unilateral displacement of the sacrum ; 
fracture of the posterior angle of the ilium and fracture through 
the symphysis. Exostoses also may lead to constriction of the 
pelvis. The rachitic pelvis of a two year old heifer greatly 
resembles the juvenile pelvis ; the distance between the coty- 
loid cavities is diminished. These abnormalities of the pelvis 
may seriously interfere with the act of parturition, but they are 
rare in the cow. This is due to the fact that cows with such 
abnormalities are rarely bred and are usually rather slaughtered 


ABNORMALITIES IN THE PARTURIENT PASSAGES A Wy 3 


by the owner than given a chance for an eventual recovery after 
such a fracture. 

The treatment depends on the degree of constriction. 
When the pelvic dimensions are but little reduced, total extrac- 
tion may be possible, while a foetus relatively too large makes 
such a procedure impracticable. For further information, I 
refer to the chapter on excessive development of the foetus. 


MORBID ALTERATIONS IN THE CERVIX UTERI. 


The cervix uteri forms the connecting link between the 
vagina and uterus. Before dilatation it is firmly closed, the 
transverse folds of the utero-vaginal mucous membrane, palma 
plicata, lie so closely together that the finger cannot pass into 
the cervical canal: During natural parturition the cervix uteri 
dilates to such an extent that uterus and vagina form a con- 
tinous canal. 

Pathological states met with in practice preventing com- 
plete dilatation of the cervix are: Spasm of the circular mus- 
cular layer, total or partial obliteration and tumors. 

Spasm of the circular muscular layer is less frequent in 
practice than is ordinarily stated. The question has been 
raised whether it is possible that a tonic spasm could create a 
closure sufficient to resist the boring movements of the finger 
or hand. We must admit that muscular contraction in itself 
does not suffice, but may do so when assisted by other 
factors. 

The cervix uteri is composed of a plicated mucosa, neces- 
sary for an eventual dilatation ; further, a submucosa and a 
serosa. The muscularis consists of a strong inner layer, the 
fibres of which are circular and extend to the beginning of the 
vagina; further, an external horizontal layer, ending in the 
vagina. Between these layers numerous blood vessels and 
nerves are found. 

The cervix uteri of the cow is physiologically rigid. As a 
result of the infiltration taking place with the first pains, this 
rigidity diminishes and may be overcome by mechanicai pres- 
sure from the uterus. 


174 BOVINE OBSTETRICS 


We have seen that dilatation of the cervix uteri during 
natural birth was produced by two factors—contractions of 
the uterus and pressure of the water-bag from within the 
uterus. The former dilates the cervix somewhat and as a con- 
sequence the accessory placentze become detached around the 
internal uterine opening, so that the separated chorion is 
driven against the internal opening of the uterus by the uterine 
contractions. The folds in the cervical canal run from before 
to behind, so that dilatation must take place from within the 
uterus, and not vice versa. 

When the os uteri is opened a little by the earlier pains, 
further dilatation is affected by the water-bag. Should the 
cervical canal remain closed on account of the spasm, the 
second factor remains useless and dilatation of the cervix with 
the finger is rendered difficult on account of the anatomical 
arrangement mentioned above. Should the spasm subside 
after the uterus is exhausted (atonia uteri) the second factor of 
mechanical dilatation is wanting. 

Symptoms.—The veterinarian is usually called after the act 
of parturition has persisted for some time and the owner's 
patience is exhausted, as neither the water-bag nor “ waters ” 
appeared. The ligaments are depressed, the udder full, the 
vulva cedematous; in fact, approaching birth is announced. Even 
strong pains have been noticed. On exploration, the vaginal 
portion of the uterus is distinctly felt, but the cervix is closed. 
The calf in consequence of the uterine contractions and difficult 
placental circulation, may be dead, but usually isalive. Boring 
movements with the finger in the cervix are not very successful, 
as one or two fingers may be introduced after a great deal of 
trouble. 

Therapeutics.—The activity of the abdominal muscles in 
spasm of the cervix is much more intense than the pains. To 
all appearances the cow is able to strain violently, while the 
uterine contractions are in fact weak. When premonitory 
symptoms are present, the ligaments sunken, the udder filled, 
the vulva swollen, assistance must be rendered immediately. 
As a rule, already the owner waited too long. 


ABNORMALITIES IN THE PARTURIENT PASSAGES 175 


Formerly the os uteri was dressed with an ointment con- 
sisting of extractum belladonna and adeps suillus 1:4; some 
used soap instead. These remedies are mostly unreliable. 
A clyster of chloral hydrate per os has been recommended 
to modify the excessive activity of the abdominal muscles. 
Straining is thus greatly decreased and the danger of rupturing 
the uterus lessened. Many advise to douche the vagina every 
two hours with warm water (40° C.). This practice has been 
followed by excellent results. | 

Reichenbach gives warm irrigations of flaxseed gruel and 
camomile tea; orders spirituous liniments to the lumbar region, 
warm clothing, and internally twice daily a pint of warm wine; 
he positively prohibits vaginal explorations by the attendant. 

When the os uteri after some time dilates sufficiently, so 
that two fingers may enter, further dilatation may be effected by 
means of rotary and boring movements of the fingers and hand. 
When the foetal membranes are filled with the “ waters,”’ enter 
the cervix, they must not be ruptured, but left to produce 
further dilatation. Incising the cervix or mechanically opening 
the cervix are to be avoided. 

[In two cases of spasm of the cervix uteri good results were 
obtained by chloroforming the animals.—W. | 

Spasm of the cervix uteri, as an obstacle to parturition, is 
rarely met with. This condition is often but erroneously sup- 
posed to be met with, but at a time when parturition is yet out 
of the question,—that is, during false pains. The latter may 
manifest themselves some days, even weeks, before birth occurs. 

They consist of feeble uterine contractions, supported by 
severe straining, all of which resemble labor pains. Since 
they occur at a time when preparations for parturition are yet 
wanting, the udder flabby, the cervix closed, the ligaments 
tense, they are termed false pains. 

The etiology of false pains is yet unknown, although it is 
reasonable to presume that they depend on disturbance in the 
blood supply of the gravid uterus. 

Symptoms.— A few days or two or three weeks before the 
termination of pregnancy, certain phenomena become manifest, 


176 BOVINE OBSTErRICS 


~ 


otherwise seen only at parturition, and interpreted by the 
attendant as belonging to approaching birth. The pains have 
lasted for one or two days, appetite is diminished, rumination 
ceased, but straining persists. 

Examination finds the cow in the above mentioned state ; 
the ligaments are not depressed, the udder empty, the cervix 
closed, the calf is alive and the cow continuously strains—so 
much so, that the rectum may prolapse; the temperature is 
normal or slightly elevated, the pulse increased in frequency. 
Under these circumstances one deals with false pains in no way 
connected with parturition. The supposedly insufficient dila- 
tation and difficult parturition from it causes the owner great 
anxiety. Most owners, in spite of all explanations, believe 
firmly that these pains should be followed by parturition. 

Some years ago I was called to a breeder, whose cow had 
been in pains the whole day, although she was not due to calf 
until three weeks later. On my arrival I found the above 
mentioned symptoms; the calf was living. This man was 
utterly astonished when I assured him positively that parturi- 
tion was entirely out of the question here, while he was pre- 
pared for the worst. Since I had done his work successfully 
for years, he complied with my request, although reluctantly. 
The cow was rubbed well, covered up nicely, and received 
chloral hydrate per os. Straining ceased after a few hours, 
and twelve hours later the cow was well. Three weeks after 
this she gave birth to a living calf without assistance. 

Prognosis may be quite favorable, although there is danger 
of rupture of the uterus. It is therefore well to be guarded 
when making a prognosis when the animal is far advanced in 
pregnancy, as serious complications may arise. 

Therapeutics.—Elevation of the hind parts of such an 
animal is very desirable; in many cases this is followed by 
improvement. The administration of chloral hydrate either 
per rectum or per os is followed by very good results; large 
doses of bromide of potassium, bromide of ammonia, bromide 
of sodium, can be recommended. Some recommend opium 
preparations. But the stage of excitement, preceding depres- 


ABNORMALITIES IN THE PARTURIENT PASSAGES 177 


sion, is of disadvantage in such cases. A very simple and 
effective means consists of placing a pillow filled with warm 
hayseed upon the-lumbar region. 


PARTIAL OR COMPLETE OBLITERATION OF THE CERVICAL CANAL. 


By it is understood a partial or complete closure of the 
cervical canal or part of it, so that during birth no dilatation 
of the cervix uteri occurs. 

The causes of this atresia of the os uteri, as it is termed at 
times, may be: Retraction from cicatricial tissue following 
injuries. When in previous pregnancies labor was difficult and 
an extraction resulted in severe injuries to the cervical wall, a 
great deal of granulation tissue may follow, contracting later 
and forming scar-tissue. It happens that excessive traction 
during insufficient dilatation is followed by rupture of the os. 
During recovery the cervix is slow to close, so that conception 
may take place before the parts are healed. A cervix destroyed 
in this manner regenerates by young connective tissue, which, 
contracting later, seriously interferes with dilatation of the 
cervix at parturition. 

Cartilaginous degeneration mainly due to a deposition of 
calcium salts, is occasionally, but, happily, seldom, observed. 
In this condition dilatation of the os uteri is impossible. 

Certain anomalies occurring during foetal development 
(due to an insufficient union of Miuller’s duets), resembling 
fleshy bands, may be found lying in front of the os uteri. 

Adhesions between the walls of the cervical canal have 
been observed (Goring). 

Tumors of various dimensions now and then cause obliter- 
ation of the cervix uteri, as fibromata, leiomyomata and carcin- 
omata (Lucet, Wilhelm). 

Symptoms.—In such avimals everything is prepared for 
parturition. It sometimes happens, when the broad uterine 
ligaments and perineal fascia are relaxed, that in consequence 
of the violent pains, assisted by the abdominal muscles, the 
upper wall of the vagina and the closed os are pushed back- 
ward until they appear between the labiw of the vulva. Vag- 


178 BOVINE OBSTETRICS 


inal examination then reveals that the upper wall of the 
vagina is drawn tightly over the head of the calf. 

Especially when such a case is met with for the first time, 
it is looked upon as a most peculiar condition. The obstetri- 
cian feels a fold, and behind it the calf, and is at a loss to 
account for this phenomenon. But the os uteri, occupying the 
centre of the whole, expiains the situation. 

It is not always easy to diagnose the nature of an obliter- 
ation. In some eases it is possible to enter the uterus with one 
or two fingers, in other cases the os is so tightly shut that not 
even a single finger can be passed. Tumors and anomalies of 
embryonic origin are much more readily recognized. 

Prognosis—When an obliteration is positively diagnosed 
to be due to cicatricial tissue or cartilaginous degeneration, 
prognosis is unfavorable. Parturition of course may take place 
after forcibly dilating the parts, but such a procedure is always 
dangerous. Such dangers may be greatly modified by careful 
after treatment, which is often neglected when executed by an 
attendant. The bloody dilatation known as hyslerotomia vagin- 
alis is described under obstetrical surgery. 

Therapeutics.—Should any doubt exist as to the diagnosis, 
the various measures suggested under spasm of the cervix 
uteri may be tried. It is always advisable to attempt dilating 
the os uteri by boring movements with the finger. This 
requires much patience. I remember to have spent once two 
hours before I was able to pass two fingers into the cervical 
canal. One hour later I could pass the hand, and after two 
more hours, working altogether five hours, extraction took place. 

The operation must be the last resource, when all other 
means have failed. The experienced practitioner does not 
take the knife too quickly, but he does not hesitate to use it 
freely when it remains the only means, after repeated futile 
attempts to relieve the condition otherwise. 

Sequels.—The violent straining may be followed by a pro- 
lapsus vaginee or rupture of the vaginal walls. In the course of 
violent pains and energetic foetal movements the cervix uteri 
may become detached. 


ABNORMALITIES IN THE PARTURIENT PASSAGES 179 


Unless proper aid is rendered the foetus soon succumbs. 
It is often astonishing how long the calf lives in spite of the 
disturbed placental circulation. When birth does not take 
place, the calf usually becomes emphysematous, as the repeated 
manipulations favor entrance of air. This is followed by a. 
septic metritis and peritonitis, ending fatally within a few 


days. 
ABNORMALITIES IN THE VAGINA AND VULVA. - 


In primipare, rigidity of the vaginal walls is often observed. 
There are cases where it is difficult to pass the hand into the 
vagina, while the cervix uteri may be completely dilated. The 
diagnosis is easily made. The head and fore legs are com- 
pressed, the vaginal wall is tightly stretched. The greatest 
obstacle is met with at the junction of vagina and vestibule. 
This rigidity may depend on an insufficient infiltration of the 
pelvic organs and is at times observed in the partus prama- 
turus. The treatment strives to expand the lumen of the vagina 
and render easy the passage of the calf. At first mechanical 
dilatation with the hand is attempted. The well oiled hand is 
passed over the head of the calf and pressure exerted with the 
dorsal portion of the hand. This requires a great deal of 
patience, but is usually crowned with success on account of the 
elasticity of the vaginal walls. By pulling gently and steadily 
on the fixed head and fore legs dilatation may be effected, as 
the advancing body acts like a wedge. 

If the vulva is too narrow and the muffle of the calf’s head 
visible between the labize, we try to pull the vulva back over 
the head. For this purpose one hand on each side is placed 
against the inner surface of the vulva and forward pressure ex- 
erted while the calf is pulled in at the same time, thus pushing 
the labiz over its head. Before beginning these manipulations, 
thorough lubrication of the parturient passages is necessary ; 
even then patience is required and traction must be moderate. 

Should dilatation of the vulva be unsuccessful in this way, 
and positively no other obstacles be present, incision may be 
made into the upper commissure. Three small incisions 


180 BOVINE OBSTETRICS 


suffice, one vertical and the other two slightly oblique, but all 
three must start from one point. This would regnire a strictly 
antiseptic after treatment to prevent puerperal infection. In 
most cases the vulva tears when traction is excessive and the 
opening too small. Thus the upper commissure and the skin 
of the labize is often torn when the limit of elasticity has been 
trespassed upon. 

Faulty conformations of the vagina may interfere with the 
passage of the foetus. These are mostly the so-called fleshy 
bands or pillars which are simply incised (Harms, Kruijt). 

Schiellerup describes a case, under the title of “ Septa in 
the Vagina,” in a cow, consisting of a cord two fingers thick 
extending from one vaginal wall to the other, interfering with 
parturition. Head and neck were lying above the fore legs 
below this cord. After the cord was cut birth took place. 
In another case reported by him such a cord retarded the ex- 
pulsion of the foetal membranes. Parturition had been diffi- 
cult; the foetal membranes were wrapped around the fibrous 
cord. 

Vaginal tumors occasionally give rise to dystokia. Pedun- 
culated leiomyomata, which can be removed in the ordinary 
manner, are most frequently met with. A diffuse infiltration of 
the vaginal walls by tumors is rarely observed. Pedunculated 
polypi, often attached to the os uteri, float in the vagina. They 
may be of considerable dimensions, as large as a child’s head. 
Their removal does not result in serious hemorrhage (Lodoli- 
Tersite, Volker). 

In consequence of a traumatic vaginitis, colpitis, traumatica, 
following a previous dystokia, or, as occasionally seeu in prim- 
iparx, cicatricial tissue results, causing vaginal stenosis. In 
either case subsequent conception is possible and complete 
recovery appears to have taken place. Nevertheless, subse- 
quent parturition shows that the elasticity of the vagina has 
been greatly diminished by previous deep inflammatory pro- 
cesses, and that the passage of the calf is rendered difficult. In 
all cases where the measures mentioned under “ rigidity of the 
vagina” fail, total or partial embryotomy must be practiced. 


ABNORMALITIES OF THE EXPELLING POWERS 181 


In the parturient passages, another disturbance may occur, 
which not only seriously interferes with expulsion, but also 
endangers the life of the mother: inversion of the bladder, 
with prolapsus of the inverted parts into the vagina. This con- 
dition is very rare in the cow, as the bladder is firmly fixed by 
the strong, fibrous pubo-vesical ligaments. It is recognized in 
the vagina as a round, fluctuating tumor, about as large as two 
fists, urine dropping from its surface. The etiology, symptom- 
atology and therapeutics are discussed in “Special Surgery.” 
Of course it is plain that the inverted bladder must be reduced 
and kept in its place. Should the inverted prolapsed bladder 
yemain in the vagina, the passage of the calf would cause its 
rupture and death of the mother. 


3.—Abnormalities of the Expelling Power. 


In the expulsion of the foetus two factors are concerned : 
the contraction of the uterine muscle and the auxiliary move- 
ments of the muscles of the skeleton, known as abdominal 
‘pressure. Where one or the other factor is not sufficiently 
developed, the expelling forces become diminished, a condition 
termed feeble pains. 

When the action of the uterine muscle is diminished in 
intensity, it is termed afonia uteri. This may be due to many 
causes : excessive distention of the uterus from hydrallantois, 
twins and emphysema of the foetus, by adhesion between the 
uterus and adjoining organs, the result of a previous peritoni- 
tis. Feeble pains may also be produced by paralysants, affect- 
ing the nerve centres of the uterus. Thus the uterine contrac- 
tions are feeble and occur at long intervals in cows suffering 
with vitulary fever either before parturition or at the time the 
cervix uteri dilates. 

Abdominal presstre is lessened in hernia and pendulous 
abdomens. In the latter instance the uterus is in the state of 
anteversion, so that the expelling forces are acting in a direction 
extremely unfavorable to the passage through the genital canal. 
General weakness may also give rise to feeble pains. 


182 BOVINE OBSTETRICS 


Sequels.—As a result of weak uterine contractions the 
expulsion of the calf is retarded, and the possibility exists that 
the calf is but little advanced, so that parts of it do not reach 
the pelvic canal. With twins, the birth of the first calf usually 
takes place rapidly, while the second one is more slowly 
expelled on account of the decreased contractions; therefore 
the owner is often of the opinion that with the appearance of 
the first calf parturition is at an end, looking upon later pains 
as after pains, by which the foetal membranes are to be removed. 

I have seen cases, where the owners, thinking parturition 
was finished, feared prolapsus uteri on account of the persistent 
pains. They used all sorts of measures to prevent it, as pinch- 
ing the back of the cow, applying a truss, etc. In one ease, 
where the owner apprehended prolapsus, I found to his 
astonishment the water-bag of a second calf in the vagina. 
After removal of the truss the second ealf was born, eight hours 
after the first one. Feeble pains impeded expulsion. 

As a second effect of feeble pains, the expulsion of the 
foetal membranes (secundine) is retarded. When discussing 
hydrallantois, I referred to it. In twin births the retarded 
expulsion due to diminished contractions of the uterus are also 
observed. In the chapter on prolapsus and inversio uteri, we 
shall see that feeble pains, together with strong abdominal 
pressure, readily give rise to an inversion. 

Symptoms.—Feeble pains during parturition are recognized 
by the light pressure they exert upon the calf. The presenta- 
tion may be normal, the parturient passages prepared, and still 
expulsion does not advance. The diagnosis is easily made on 
introducing the arm into the uterus. In many the dilatation of 
the cervix uteri is incomplete, partly due to the insufticient 
uterine contractions and consequently limited mechanical action 
of the water-bag. 

Therapeutics.—Treatment is only of use in few cases; for 
instance, in excessive distention of the uterus; in those cases 
we can effect some uterine contractions. Success at the same 
time is but small, and it is much better to practice traction. 
Care must be taken to guide the force of the expelling powers, 


ABNORMALITIES OF THE EXPELLING POWER 183 


especially abdominal pressure, in the direction of the parturient 
passages. This was emphasized when dealing with anteversion. 
During the process of involution we may attempt to encourage 
uterine contractions directly or indirectly, the former by irriga- 
tions with cold water, the latter by administering ergot of rye. 
Violent pains may disturb the normal course of birth and 
render difficult reduction of abnormal presentations. Although 
such pains seldom induce hurried parturition (partus precipi- 
tatus), they may lead to circulatory disturbances, even death of 
the foetus. 

In many instances, when violent pains are mentioned, severe 
abdominal pressure is meant. During the process of involution 
it may result in prolapsus uteri. 

Therapeutics.—In order to diminish severe straining, inhal- 
ations of ether, chloroform, morphine subcutaneously, chloral 
hydrate per os, as clyster, may be administered. A simple 
means to lessen straining consists in putting the cow on the 
back or in elevating the hind legs. Some owners tie a curry- 
comb to the back of the cow, or pinch the skin over the spinous 
processes of the lumbar vertebrae with tongues—brutal manip- 
ulations, decidedly to be prohibited. 


II. 
ABNORMALITIES OF THE FETUS. 


1.—The Foetus Absolutely and Relatively too Large. 


In either case the foetus is too large, rendering normal 
parturition impossible. The foetus absolutely too large may 
coexist with a normal pelvic canal; a foetus relatively too 
large represents a normally developed calf in a constricted 
pelvis. 

The foetus absolutely too large may be out of proportion to 
all parts of the pelvis; but may be excessively developed in 
certain diameters, preventing its passage on certain places of 


the pelvis. 


184 BOVINE OBSTETRICS 


Excess of volume of the head, inherited from the father, is 
frequently observed. Bulls with massive heads are not liked, 
as experience teaches that the big heads of their calves often 
give rise to dystokia. 

The excess of volume of the anterior extremity of the body 
mostly confines itself to an over development of the muscles of 
the shoulder and pectoral region. Such calves with wide 
breasts and fleshy shoulders meet with obstacles in the pelvic 
canal during parturition. 

The so called square buttocks, ‘ Biren-Hinterer,’ low 
German, “ Birevot,” Belgian “Cul de poulain,” Hollandish 
“ Paarden” or “ Steenbil,” are characterized by an extraordinary 
development of lumbar and gluteal muscles. The loins and 
buttocks form a rounded mass, arched on either side of the 
sacrum, so that its spinous processes lie in a groove. The tail 
is thin, while the bones of these calves are delicate and fragile. 
The distance between the external angles of the ilia is not too 
great, but the width between the trochanters forms a distinct 
obstacle to parturition. 

By double-enders we mean calves with excessive muscular 
development of the anterior and posterior extremities of the 
body. They have a short, wide head, short neck, wide breast 
and fleshy shoulders. Back and loins are strongly muscular, 
so that the spinous processes lie in a groove. The muscles of 
the hind legs are greatly developed, the tail is thin. The 
bony frame of such calves is not proportionately developed to 
th» muscles, the shin-bones are short, the diaphyses thin. 
They weigh from 50 to 80 kg. Such a double-ender, when 
born alive, is usually fattened and may weigh from 100 to 
120 kg. at an age of eight weeks. During parturition, long, 
thin legs do not point to an excessively developed ealf. But 
anybody engaged in obstetrics some time recognizes the double- 
ender at once by its short shin-bones with heavy epiphyses 
and thin diaphyses, expecting a tedious extraction. 

Course of Parturition—In anterior presentations, where 
the head lies upon the fore legs, birth advances until the head 
and fore legs progress into the vagina as far as the carpi. At 


ABNORMALITIES OF THE FMTUS 185 


the moment when the withers come opposite to the pelvic 
inlet, birth is retarded. On examination the head is found 
resting on the fore legs, the calf’s chin resting upon the claws. 
The latter is due to the fact that the elbows, on account of the 
fleshy shoulders, cannot enter the pelvic canal, and the anterior 
limbs remain a little behind. When chin and claws lie in the 
vulva at the same time, it is frequently an indication of an ex- 
cess of volume of the calf. 

Dilatation is mostly complete, preparation for both having 
extended over quite some time. In the posterior presentation, 
with the hind legs in the parturient passages, the posterior 
limbs have sufficiently advanced to protrude beyond the vulva 
at each pain; as a rule, one leg appears up to the fetlocks and 
about one-half of the metatarsal bone of the other. Parturi- 
tion is difficult, as the trochanteric diameter exceeds the pelvic¢ 
dimensions. The thin tail and the strongly developed gluteal 
muscles detected on exploration suggest the double-ender. 

The owner always attempts to extract the calf. When in 
an anterior presentation he secures the fetlocks, and with the 
aid of other people an attempt is made to extract the calf. In 
some cases, where the cow is well developed and has a wide 
pelvis, extraction may succeed, but in most cases the calf is 
partly extracted, and when the withers are caught in the vulva, 
parturition comes to a standstill. The trochanteric diameter, 
as well as the distance between the patelle, may be too great 
for the diameters of the pelvis. 

In postericr presentations, with the hind legs in the par- 
turient passages, the owner also pulls here, and often success- 
fully. After the posterior extremities are once delivered, the 
anterior portion of the body rarely interferes with parturi- 
tion. 

But in many cases the attendant does not succeed in ex- 
traction, and the veterinarian is called in. When the excessive 
traction exerted by the owner results in fracture or luxation, 
the surgeon has a disagreeable task before him. Under such 
conditions the termination is unfavorable, as such animals 
remain in the recumbent position often for a long time. Should 


186 BOVINE OBSTETRICS 


the animal be still able to stand up on our arrival, the prog- 
nosis is more favorable. 

Treatment.—With the foetus in the anterior presentation, 
we first acquaint ourselves with the position of the calf and 
conditions of the pelvic inlet. Head and fore legs are corded, 
the former by means of loop around the lower jaw, or a cord 
around the head, respectively, an obstetrical head-stall; the 
latter by loops above the fetlocks. The cow is fixed by placing 
a surcingle around the buttocks, securing it to the posts on 
either side of a stall. The dutch collar of a horse may be used 
to good advantage. The breast strap is put around the hind 
legs about 8 inches below the vulva, and. the neck strap over the 
lumbar region, while the traces are either fastened or held 
otherwise. In this manner the cow is not displaced. 

It has happened to me repeatedly that a cow was drawn 
out of the stall when traction was exerted by two men. This 
necessitates the removal of the cow to her first position before 
the obstetrical operation can be continued. Such an interrup- 
tion is disagreeable to the obstetrician, and may be dangerous 
to the mother. 

After placing the cow upon the right side and taking up 
the cords fixed to the head and fore legs of the calf, alternate 
traction is exerted upon the anterior limbs to reduce the 
bicostal diameter of the thorax shoulders, by the thickness of 
one shoulder. After the fore legs have been advanced to the 
extent that the chin occapies the middle of the metacarpal 
bones, traction is applied to the head. ach fore leg and head 
is turned over to one man. At the same time the force 
exhibited by three men must never be exceeded. 

Care, of course, must be taken that the feet of the three 
men are braced, to prevent slipping and thus jerking the ani- 
mal. Traction, moderate at first, is gradually increased, but 
must be uniform at all times. 

Before extraction is begun lubrication of the parturient 
passages is necessary, and no doubt should exist that the cer- 
vix uteri is completely dilated. 

Such extraction must be practiced with a great deal of 


ABNORMALITIES OF THE F@TUS 187 


patience. Instances are known where eight to ten men ex- 
tracted a calf and everything went well, but we must not set 
such brutal examples, the results of which are usually serious. 
Experience teaches, also, that eight to ten men do not develop 
much more power than three men, as they cannot be stationed 
properly to pull to advantage, and that the exerted force 
greatly decreases after a time. 

How variable traction is, and its decrease, may be seen by 
referring to the following table: 





FORCE EXERTED BY TRACTION (EXPRESSED IN KILOGRAMS) BY 








ONE MAN. TWO MEN. THREE ,MEN. FOUR MEN, 








At the |After 45| At the’ |After 45| At the |After 45 | At the |After 45 
outset. | seconds.| outset. |seconds.| outset. | seconds.| outset. | seconds. 














112 100 200 100 B24 150 350 150 
97 10 195 175 200 150 275 175 
70 5d 125 50 a 500 225 175 
60 60 °100 60 bce 300 phate 




















The feet of persons who pulled were braced, their position 
was the same as in parturition of an animal in the recumbent 
position. The dynamometer was employed to measure the 
force exerted. After one minute the men showed decided 
fatigue, from which they quickly recovered. 

When extraction is unsuccessful in this way, the calf is 
usually dead. Partial or total embryotomy is then indicated, 
an operation much less dangerous, when properly executed, 
than a forced extraction. (See p. 260.) 

A huge foetus in the posterior presentation, with its hind 
legs in the parturient passages, when pulled at unsuccessfully 
by three or four men, is no reason why further extraction 
should be abandoned and embryotomy performed. The treat- 
ment should be the following: After securing the cow and 


188 BOVINE OBSTETRICS 


convincing ourselves that the cervix uteri is fully dilated, vulva 
and vagina are oiled and the tail of the calf is pulled to one 
side during extraction. The hind legs are corded at the 
fetlocks. 

In many cases we can estimate on exploration the tro- 
chanteric diameter of the calf and the transverse pelvic diam- 
eter. An approximate mensuration by hand of the various 
dimensions enables us sometimes to decide upon the possi- 
bility of extraction. One man takes care of a hind leg. While 
both men pull at the same time, each on one leg, the obste- 
trician guides both ropes and takes care that traction is 
exerted in the right direction. When this method is unsuccess- 
ful, two men pull on one leg, drawing it out as far as possible. 
After the hock of the leg has thus passed beyond the vulva, and 
the fetlock of the other leg just projects at the vulva, the leg 
drawn out most is fixed by a man—that is, held in place to 
prevent its return. Now the other leg is extracted, and in 
many instances the trochanteric diameter slips obliquely 
through the vertical diameter of the pelvic inlet, and the pos- 
terior half of the body can be delivered. The cords are next 
attached above the hocks, traction is exerted on both hind 
legs, and parturition is finished. This method, often yielding 
good results, should always be given a trial. Where extraction 
does not succeed, partial, or total, embryotomy must be per- 
formed. 

The fetus relatively too large exceeds the dimensions of the 
pelvic canal, The calf may be normally developed, but is too 
large for the constricted pelvis. We often see it in primipare, 
the two-year-old heifer. The only obstacle in such a juvenile 
pelvis lies in the decreased diameter between the cotyloid 
cavities. At the same time it may happen that the calf is 
absolutely too large. On account of the small head and fore 
legs lying in the vulva, the owner imagines the calf of ordinary 
size, aud often exerts violent traction. In some cases he is 
successful; in many cases the calf is only born as far as the 
withers, as the trochanteric diameter cannot pass the pelvic 
inlet or pelvic canal. Weare often told in practice that at such 


EMPHYSEMA OF THE FETUS 189 


and such a place erght to ten men pulled and successfully 
delivered a calf. This is due to the great elasticity of the foetal 
pelvis as well as that one of the heifer not yet completely 
ossified, and therefore capable of some distention. 

The treatment is the same as in the foetus relatively too 
large. When the anterior half of the calf is born, and excessive 
traction previously practiced, embryotomy may be performed 
immediately, consisting in the removal of the anterior extremi- 
ties of the body, evisceration and reduction of the pelvis. 
Some practitioners, after dividing the foetus, rotate the hind 
legs and pull them into the-pelvic canal, where they may be 
extracted or one leg removed. 

This is fully discussed under embryotomy. In cases where 
the anterior portion of the calf has been born for several hours, 
while the hindquarters are still in the pelvic canal, prognosis 
after termination of birth is not favorable. The mechanical 
dilatation of the parturient passage may be followed by reflec- 
tory paralysis, in consequence of which the cow never rises or 
only after along time. The tension of the vaginal walls may 
produce circulatory disturbances and gangrene. 


2.—Emphysema of the Foetus. 


Definition We understand by this designation a foetus 
decomposed within the uterus, the gases of such a decomposi- 
tion causing a general emphysema; being of a subcutaneous, 
intermuscular and subserous type. 

Etiology —The foetus may die at any time of the period of 
pregnancy. The causes are either found in the mother, as cir- 
culatory disturbances—for instance, in torsio uteri—or in the 
calf. Putrefaction can only occur where air enters so that the 
bacteria of putrefaction may exert their influence. No putre- 
faction takes place when the foetal membranes are intact, as 
the bacteria cannot penetrate them (Franck). 

When the foetus dies and the waters are partially dis- 
charged, the foetus may remain in the uterus on account of the 
encumbered expulsion, and decomposes. Expulsion may be 


190 BOVINE OBSTETRICS 


interfered with by a malposition of the calf, insufficient dila- 
tation of the cervix uteri, or by a foetus absolutely or relatively 
too large. 

After the calf dies and air enters freely, putrefaction soon 
sets in, as the development of putrefactive bacteria is favored 
by the body temperature. The foetus becomes an incubator 
of low organisms. 

As a result of the putrefactive gases, blisters form all over 
the skin. Here and there blisters from dollar to fist size form, 
become confluent and distend the skin over a large area. 
In the intermuscular tissues blisters also form. The blood 
decomposes most rapidly. Since the tissues are saturated 
with plasma, stained with the coloring matter of the red blood 
cells, the muscles and glandular organs show a dirty red color. 
The liver, being full of blood, quickly decomposes. It has a 
mottled and pasty appearance. The latter is caused by the 
blisters formed underneath the serosa. In consequence of the 
decomposition and chemical changes of the constituents of the 
tissues, sulphuretted hydrogen, various carbonated hydrogen 
gases, ammonium and butyric acid forms. The sweet and fetid 
air coming from such a foetus is especially noticeable on 
exploration. 

Symptoms.—The death of the foetus is characterized by 
phenomena occasionally overlooked by the owner. The symp- 
toms indicating birth of the emphysematous foetus are suffi- 
ciently plain to be appreciated by him. 

Putrefaction of the fcetus toward the end of pregnancy— 
that is, at a time when natural birth should occur—is of great 
importance to obstetrics, as parturition is impossible on account 
of the excessive dimensions of the calf. When we are called 
to treat such cases, the owner often imagines indigestion pre- 
sent rather than approaching birth. The cow eats but little, 
defecation is hard and retarded, rumination has ceased and 
some tympanitis is noticeable. Examination reveals that the 
cow is in a state where birth may take place. There is com- 
plete, or partial, depression of the broad ligaments, the udder 
is filled, the left as well as the right side of the belly is dis- 


EMPHYSEMA OF THE FETUS 191 


tended, especially in the lower abdominal region. The general 
state of health is more or less depressed, although such animals 
may be apparently well,—even cover considerable distances, 
The temperature is 39.5° to 40.5° C. 

When the examination confines itself only to inspection, 
the true course of the symptoms may be overlooked, especially 
as the pains are very feeble in such cases, and are only ob- 
served with difficulty on account of the great distention of the 
uterus. The failure to make a vaginal exploration would lead 
to unfortunate consequences in such a case. In some animals 
the attendant observes the discharge of the foetal waters, or 
dejection of a fetid, chocolate-colored liquid from the vulva; or 
the secundine may partly hang from the vulva. Such symp- 
toms soon help us to recognize this condition. 

Exploration throws still more light upon the case. The 
hand introduced into the vagina immediately feels the in- 
creased heat in the parturient passage. Sometimes, as the 
result of insufficient preparation for birth, the cervix uteri is 
but little dilated ; the os uteri may be sufficiently dilated, but 
in most cases no complete dilatation occurs, since the mechani- 
cal dilatation by the water bag did uot take place ; neverthe- 
less, the hand can, as a rule, be passed into the uterus. 

The distended calf, tightly enveloped by its membranes, is 
felt in front of the uterus. The uterus, mostly contracted, is 
moulded upon the calf when the greater portion of the foetal 
waters has escaped. By stroking the calf with the hand a 
distinct crackling is observed as the gases accumulated beneath 
the skin are displaced by the pressure of the hand. The calf 
feels like dough. It is rounded in shape, the hairs are easily 
pulled out, the claws sometimes can be stripped off, unless 
they are already lying in the uterine cavity. When putrefac- 
tion is far advanced the bones of the head separate at the 
sutures, and the epiphyses and diaphyses of the long bones 
can be drawn apart. The whole gives off an unbearable stench, 
adhering for days to the clothing. A dirty brownish, fetid 
liquid escapes from the vulva during and after the exami- 
nation. In multiple gestation, it. happens occasionally that 


192 BOVINE OBSTETRICS 


one calf is born alive while the other is emphysematous 
(Albrecht). 

As a rule, decomposition sets in eighteen to thirty-six 
hours after death of the foetus; but, before it becomes com- 
pletely emphysematous and enormously distended, before the 
hairs fall out and claws drop off, forty-eight hours or more 
may pass. j 

Course and Prognosis.—Uuless professional aid is rendered, 
the termination is fatal. The cow dies within a few days with 
septiceemia, unless the course of the trouble is hastened by 
rupture of the uterus and septic peritonitis. Even with proper 
treatment, 1 guarded prognosis must be given, as we cannot 
predict the effects of toxins already taken into the circulation. 
Besides, a septic metritis following retention of the afterbirth 
may terminate fatally. The prognosis in general should be 
“doubtful.” 


THE OPERATOR'S PROPHYLAXIS. 


When delivering an emphysematous foetus, it is essential 
to consider even very small wounds of the hands and arms. 
Especially abrasions and wounds about the finger-nails are 
often overlooked and serve as an entrance to infection. Small 
wounds and abrasions should be covered with iodoform- 
collodium or collodium elasticum, or painted with tincture of 
iodine; the iodine remains as a protective antiseptic cover 
after evaporation of the alcohol. While at work, a pail with a 
2 per cent. creolin solution should be kept at hand, to wash 
hands and arms now and then. The oiling of the arms and 
hands with ecreolin oil (1 part creolin to 20 parts of oil) must 
be done with great care. The obstetrician must never neglect 
this preparatory treatment. Experience teaches that by deliv- 
ering such cases local infections occur, which endanger the life 
of the surgeon unless attended to. 

Treatment.—When possible, total extraction should be 
attempted. Although the changes render the calf very pliable, 
extraction rarely succeeds, as the parts usually separate 
wherever they are corded. We start by oiling the genital 


EMPHYSEMA OF THE FQTUS 193 


passage and by injecting large quantities of warm water into 
the uterus to prevent suction. The cervix uteri, when not 
fully opened, is mechanically dilated by the hand. Extraction 
may uow be practiced. 

The head and fore legs, when occupying the vagina, are 
secured, the former by hooking the orbital cavity or by loop- 
ing the neck, the latter by cords above the fetlocks. It is not 
advisable to loop the inferior maxilla of the calf, as it is easily 
torn off. In the posterior presentation, both hind legs are 
guided into the pelvic canal and corded above the fetlocks. 

The force of two menis employed for extraction. Unless 
putrefaction is too great, and the calf of ordinary size, extrac- 
tion may succeed. Many veterinarians make numerous in- 
cisions into the skin of the calf with a sliding bistoury, to 
diminish the volume of the calf. The result is not satisfactory. 
In most eases nothing is of any use, the hooks tear out or the 
shin-bones break, when strong traction is exerted. 

But we must not allow things to reach that point, as the 
sharp bones of the leg and the broken upper jaw would injure 
the uterus or vagina. When decomposition is well advanced, 
the strength of one man suffices to sever the leg at the point 
the cords are fastened. Such cases where everything tears 
which is fixed, are especially discouraging to the beginner, but 
here again patience will bring about a happy termination. 
Where extraction is impossible, embryotomy must be per- 
formed. We must remember at the same time that it is 
impossible to do a regular embryotomy ; for instance, when we 
begin with one fore leg and skin it, its removal as a whole is 
not to be expected, as it frequently separates at the carpus or 
elbow-joint. In such acase the different bones of that fore leg 
are to be removed individually before the other fore leg is 
operated upon. The amputation is readily accomplished. The 
reduction of emphysematous calves is difficult and tedious 
work, requiring a great deal of patience. By means of embry- 
otomy it becomes possible, although requiring often a good 
deal of time. The results are best when the operation is done 
subcutaneously and not too much traction practiced, it greatly 


194 BOVINE OBSTETRICS 


lessening the danger of aninjury. Very small wounds of the 
parturient passages may form the focus of a fatal infection. 

The after-treatment in such animals is of the greatest im- 
portance. Whenever possible, the placenta must be removed 
immediately after parturition, since its decomposition forms an 
excellent medium for pathogenic micro-organisms. Insnfficient 
contraction of the uterus prevents their manual removal, as all 
the cotyledons cannot be reached by the hand. In either case 
antiseptic uterine irrigations must be employed. For that 
purpose a 1 to 2 per cent. creolin, lysol or alum solution is 
indicated. 

After removal of the afterbirth, the uterus is thoroughly 
irrigated with cold water. I have frequently succeeded in 
lowering the body temperature in one hour one degree by irri- 
gating the uterus with cold water. This is followed by an 
irrigation with creolin solution, which is allowed to run out of 
the uterus. Should it be impossible to remove the afterbirth 
by hand, the uterus is to be irrigated twice daily with a 1 per 
cent. warm creolin solution. After a few days the uterus con- 
tracts sufficiently so that the cotyledons can be reached and the 
afterbirth removed. Now the irrigations are continued once 
daily until the os uteri closes to the extent that the hand cannot 
be passed any longer and the discharges of the uterine secre- 
tion have become very limited. Internally, antiseptics are 
given, camphor with oleum terebinthinia (camphorie, 5.0; 
olei terebinthine, 15.0; pulv. rad. althaew, 40.0; fiat pulvyis, 
dentur tales doses iv.;'S. twice daily one powder). The ad- 
ministration of borax in large quantities (100 g. per day) can be 
recommended. 

After such a prolonged case of dystokia, leaving the cow 
more or less soporous, coffee with wether may be given. 

The cords used in this parturition are to be burned to 
prevent their infecting an animal at another occasion. The 
iron instruments are to be heated. Simply rinsing them in 
the creolin or carbolic acid solutions is insufficient; the many 
depressions on the filed surface make a thorough disinfee- 
tion by rinsing them an illusory one. 


DROPSY OF THE F@TUS 195 


3.—Dropsy of the Foetus. 


Dropsy of the brain, hydrocephalus, as well as dropsy of 
the skin, anasavca, and dropsy of the abdominal cavity, ascites, 
form obstacles to parturition. 


(A) HYDROCEPHALUS. 


A great deal of fluid is found in the cranial cavity, causing 
atropy of the brain, distention and atropy of the cranial 
bones (fig. 19). 





Fig. 19.—Hydrocephalus. 


Symptoms.—When the hydrocephalus enters the pelvic 
inlet, resting on the fore legs, the claws of the fore feet extend 
as far as the vulva and no further. Asa rule, the calf does not 


196 BOVINE OBSTETRICS: 


rotate completely ; after partial discharge of the foetal waters 
and while the fore legs pass into the pelvic canal, the hydro- 
cephalus lies laterally or sinks down between the anterior 
limbs. On exploration, the strongly distended head is not 
always recognized immediately as such, as it fluctuates on 
pressure. A careful examination soon explains matters. 

Treatment.—W henever possible, the head should be placed 
upon the fore legs. For this purpose the calf is pushed back 
into the uterus, the inferior maxilla is grasped with the hand, 
or corded and drawn. 

After the normal presentation has been established, the 
head is fixed as mentioned above, and a long, deep incision is 
made with the slidiig bistoury along the suture of the cranial 
bones (Fontanelle). It is impossible to split the head without 
fixing it, as it recedes from the pressure of the knife. After 
the incision, a serous fluid is evacuated, while in many cases 
the dimensions of the skull remain the same. The fragile 
plate of bone underlying @ thin skin can be crushed by the 
hand. With the head in the vagina, the cranial bones can be 
readily caved in by placing the hand between the head and 
upper vaginal wall and pulling on the fore legs. Some advise 
to remove the head with the chain saw, after it is firmly fixed, 
so that decapitation occurs in the region of the atlas. Should 
it be impossible to extract the foetus as a whole after incising 
and crashing the cranial bones (cephalotripsia), the subeu- 
taneous removal of one or both fore legs is the easiest method. 
After that the hydrocephalus can be drawn into the parturient 
passage. 

Deneubourg passes a long hook into the mouth and 
attempts to destroy the floor of the cranial cavity. From here 
strong traction on the hook shall destroy the base of the 
cranium and evacuate the fluid. 

Hydrocephalus is mostly seen in the anterior presentation. 
In the posterior presentation (Lassartesse) the condition is 
frequently only recognized after partial embryotomy. Deneu- 
bourg describes a case, where twin calves with hydrocephalus 
and both in the posterior presentation were born. 


DROPSY OF THE F@TUS 197 


(B) ANASARCA AND ASCITES. 


Anasarcea in the calf occurs in connection with ascites and 
hydrothorax. Calves of this kind are designated “lard calves” 
(Speckkdlber) or “moon calves” (Mondkilber). On account of 
dropsy, the foetuses are of enormous dimensions, and in an 
ordinary presentation are twice as wide as a normal calf. It is 
rounded in shape, the trunk forms a short cylinder, from which 
in front the head and laterally four short legs project as a 
result of the cedematous state of the subcutaneous and inter- 
muscular connective tissue. Such hydropic calves are usually 
born at the seventh or eighth month of pregnuncy. As a rule, 
they are hairless, the hide resembling chamois-skin. 

Aitiology.—tt is decidedly doubtful whether hydropsy of 
the foetus follows dropsy of the mother and co-exists with it; 
on the contrary, this cedematous condition depends on diseases 
of the foetus. Franck mentions the post-mortem of a dropsical 
ealf, where hydropsy was produced by the absence of the 
ductus thoracicus and larger lymph vessels. Schurink (Hol- 
land) found in a dropsical calf, born seven weeks before the end 
of pregnancy, kidneys weighing together 4.25 kg. Arloing 
(St. Cyr and Violet) mentions a similar case, where the kidneys 
weighed 2300, respectively 1990 g. The liver weighed 2.6 kg. 
Cystic degeneration of the kidneys was present. Noeard de- 
scribed a very exact autopsy of a calf with ascites. The liver 
weighed 2.5 kg. The left ventricle of the heart showed chronic 
valvular endocarditis. 

In some instances dropsy of the foetal membranes is pres- 
ent at the same time. Hermenier observed a case of dropsy 
of the kidneys giving rise to dystokia. The kidneys were four 
times as large as the head cf a man and contained 15 1. of fluid. 
Hermenier offers as cause for this dropsical change the absence 
of the urachus. 

Diagnosis.—It is not very difficult to recognize such a 
so-called “lardaceous” calf. In the anterior presentation the 
small fore legs have hardly entered the pelvis. Exploration 
reveals the doughy, fluctuating surface of the calf, the rotundity 


198 BOVINE OBSTETRICS 


and enormous size of the trunk. The impression is conveyed 
as if the whole calf is a large elastic ball. In the posterior 
presentation, with the hind legs in the pelvic canal, the claws 
reach only as far as the vulva. Exploration reveals the 
rounded buttocks and the fluctuation of the body. 

Treatment.—The total extraction of such a calf rarely suc- 
ceeds; as a rule, embryotomy must be performed. But we 
may first attempt to reduce the size, by many long and deep 
incisions into the cyst of the skin along the shoulders and back, 
evacuating the amber-colored liquid contained within those 
cysts. Should this be successful, extraction may then be 
attempted. Since the trunk of the calf is very elastic, strong 
traction—for instance, four men—may be exerted without 
danger. When extraction is out of the question, the fore legs 
are amputated and evisceration performed. Parturition, as a 
rule, then takes place when traction is practiced on the head 
and the two flaps of skin of the removed fore legs. Complete 
embryotomy is performed when necessary. Adler-Rottenbuch 
recommends to open the cysts in the skin; next, to secure the 
head with a thin rope and to draw it outside the vulva. The 
head is amputated and the cord is placed around the calf 
behind the fore legs. Now a long incision is made into the 
abdominal cavity, and the act of parturition is brought to an 
end by slow traction of six to eight men. 

When the “lard calf” lies in a posterior presentation, first 
one hind leg and one half of the pelvis of the same side and 
then the intestines are removed. In order to get rid of the 
fluid, long, deep incisions are made along the back. By pull- 
ing on the remaining hind legs the whole calf can be extracted. 
It is advisable to fasten the cords in such calves as close to the 
trunk as possible. For instance, on the fore legs the loops are 
placed above the carpi, and on the hind legs above the hocks. 

Ascites in the calf may be so extensive that parturition 
cannot take place without aid. Occasionally calves with ascites 
are aborted, but they may be hairy and carried to the end of 
the term. Hydropsy may confine itself to the thorax and 
abdominal cavity ; anasarca may be entirely wanting. 


DROPSY OF THE FETUS 199 


Diagnosis.—When a calf with ascites is born in the ante- 
rior presentation, parturition is interrupted as soon as the 
anterior half of the body has been born; the distended abdomi- 
nal wall lies in front of the pelvic inlet. The attendant, who 
already pulled on the thin fore legs and small head, is aston- 
ished that he cannot extract the ecalf,and thinks of an abnormal 
development of the posterior portion of the body. Manual 
examination detects the exceedingly soft distention and fluctu- 
ation behind the last ribs of the calf. 

In the posterior presentation, with the hind legs in the 
pelvic canal, the posterior limbs do not pass any further 
beyond the vulva than half the length of the metatarsal bones. 
In this position exploration and diagnosis are much easier. 

Course.-—When the owner pulls very hard, after the ante- 
rior extremities of the body are born, it may ‘happen that 
suddenly a loud report manifests itself, terrifying those en- 
gaged in traction, followed by easy extraction of the calf. 
Those present wonder at the amount of force required to 
extract such a small calf. Soon after the calf is born a great 
deal of fluid is discharged from the uterus. The cause of this 
phenomenon, as well as the course of parturition, is easily ex- 
plained. The extraordinary tension resulting from traction 
ruptured the abdominal wall. In bull calves with ascites the 
abdominal liquid may be pressed into the scrotum, distending 
the latter to an extent that interferes with birth. Severe trac- 
tion may rupture the scrotum, and the liquid is evacuated. 

In most cases the attendant’s resources are exhausted and 
he sends for the veterinarian. 

Treatment.—In those cases where one half of the calf is 
born, one fore leg and five to six ribs of the same side are 
removed. After removal of the thoracic viscera the diaphragm 
is punctured by hand and the fluid in the abdominal cavity is 
allowed to flow off. When necessary, the contents of the ab- 
dominal cavity are removed, and parturition is finished by 
simple extraction. 

A. Horner suggests to pass the probang when the anterior 
half of the calf is born, to remove the water of the abdominal 


200 BOVINE OBSTETRICS 


cavity. A few strong blows suffice to perforate the rumen, 
traction is exerted upon the fore legs and the water flows out. 
In this manner he met with good results in three cases without 
performing embryotomy. 

In the posterior presentation, with the hind legs in the 
parturient passage, one hind leg and the pelvic half of the 
same side is removed; after evisceration the calf is extracted 
by the other hind limb. Should abuormal presentation be 
present, reposition is first practiced, followed by the above 
described procedure. 


4.—Monstrosities. 


Vice in conformation of the foetus does not necessarily 
form an obstacle to parturition. Many monstrosities are born 
without aid. Only those shall be mentioned of importance to 
obstetrical practice. 

Classification.—Monstrosities may be divided into two main 
groups, viz: simple and compound monstrosities. To the 
former, among others, belong the acardiacus, the “ otter calf,” 
divisions of the head and trunk, peromelus and perosomus 
elumbus. 

Enumerated among the compound monstrosities are the 
diprosopus, dicephalus, ischiopagus, pygopagus, dipygus, prosopo- 
thoracopagus, synkephalus, craniopagus, thoracopagus (sternopagus 
and xyphopagus), and polymelus. 

The “otter calf,” or calf with congenital rhachitis (fig. 20), 
has very short limbs. The diaphyses are short, the epiphyses 
very wide and thick. Palatoschisis, hydrocephalus and bra- 
chygnatus is often present. 

The excessive bicostal and bitemporal diameter of such 
calves may render parturition difficult. Nevertheless, after 
oiling the passages well, extraction is mostly suecessful, by 
pulling on the legs or leg, by hooking the inner canthus of the 
eye. Should this fail, embryotomy is indicated. 

Olefts of the Head and Trunk.—Here belong, among others, 
the cranioschisis and rachischisis, as well as the ectopia vis- 


MONSTROSITIES 201 


cerum. To the latter: schistosoma, fissura abdominis, or real 
abdominal cleft, from navel backward including pubis. 

The schistosoma reflecum is a monstrosity quite frequently 
observed in the cow (fig. 21). Franck mentions 39 cases; 
St. Cyr saw 11 out of 49 monstrosities ; Rieck, 49 out of 197 
monstrosities. The teratological museum of the veterinary 
school at Utrecht has 13 skeletons, also some parts of calves 
eurved backward. Franck compares the latter monstrosity 
very properly with an acrobat whose body is bent forward 
until the hands touch the ground, so that the superior and 
inferior imbs come together. 





Fig. 20.—The ‘‘ otter calf.” 


The spinal column has a double S-curve, so that the pos- 
tero external angle of the ischicum lies in the region of the 
fifth cervical vertebra. The ribs, usually bent upwards, are 
crowded and frequently grown together, forming, so to speak, 
a plate in which the few fissures point to former ribs. The 
intestines are exposed. 

Symptoms at Parturition—In many cases the attendant 
first notices the protrusion of intestines at a time when the 
legs enter the parturient passage. Sometimes pretty strong 
pains are present and the intestines of the calf do not enter the 
vulva. On exploration, a broad mass surrounded by intestines 


202 BOVINE OBSTETRICS 


is felt. Continuing palpation, one or more legs, the curved 
spine and occasionally the head is recognized. 

Prognosis—On the whole, it is favorable. Experience 
teaches that the schistosoma is quite elastic, and consequently 
can mostly be extracted in spite of the abnormal position. 



































Fig. 21.—Schistosoma Reflexum. 


_ Treatment.—Many obstetricians first tear the intestines 
loose by hand and remove them. Others allow an assistant to 
fix the intestines outside the vulva, attempting to secure the 
hind legs by means of cord and loop. There is no definite 
method for the extraction of this monstrosity. A good deal 
depends on whether part of the body is accessible or not. 


MONSTROSITIES 203 


When it is possible to recognize the curved spinal column 
and cord it, it is advisable to fasten the chain saw to this rope 
and to pull it far enough to run through the vertebral column. 
After dividing the monstrosity in this manner, extraction may 
take place. 























































































































Fig. 22.—Perosomus Elumbus. 


Extraction is often successful when a hook can be securely 
fastened in the pelvis. Whenever necessary, the fore and hind 
legs may be removed, followed by extraction of the foetus. 

J. van Klaveren (Holland) reports three cases where he 
successfully delivered the schistosoma. _ He did not sever the 


204 BOVINE OBSTETRICS 


intestines, but removed the presenting limbs. Extraction 
could then always be accomplished by the two remaining legs. 

Perosomus elumbus (fig. 22) may give rise to dystokia. In 
this monster the lumbar vertebrae are wanting. It is com- 
pletely covered with skin, only the spinal column is not 
continuous. oder also describes such a case. 

Of the compound monstrosities, I mention the diprosopus 
(fig. 23), the face of which is more or less double. On exami- 
nation, one may at first imagine to deal with twins. But when 
the head is pushed back the other follows the movements and 
the skull common to both, and the actual state of affairs is 
recognized. 





Fig. 28.—Diprosopus. 


Treatment.—A hook is fastened into the internal canthus . 
of one eye, and attempts are made to bring the double head in 
an oblique direction through the pelvic canal. As a rule the 
fore legs, which also occupy the parturient passage, interfere 
with this operation. After removing them subcutaneously the 
head is mostly able to pass. Should it still be unable to glide 
through the pelvic canal, the chain saw easily and quickly cuts 
through the skull. 

The dicephalus (fig. 24) may be treated in the same manner 
as the diprosopus. In case the division extends far backward, 
partial embryotomy may be resorted to. 


MONSTROSITIES 205 


The pygopagus.—Dr. Vaerst, at Meiningen, described an 


























Fig. 24.—Dicephalus. 


interesting case. After the first calf was almost completely 





Fig. 25,—Pigodidymus Aversus (Vaerst). 


born, it could not be extracted. By exerting traction with six 


206 BOVINE OBSTETRICS 


to eight persons the second calf followed, grown to the hind- 
part of the first one (fig. 25). The calves, fully developed, 
possessed a common umbilicus and were 14 m. long. The 
umbilicus is visible in the drawing between the hind legs. 
Gurlt designates this monstrosity as pigodidymus aversus. 
Vaerst truly says: “For the 
obstetrician such a monstrosity 
is a hard nut to crack.” When 
the first calf protrudes from the 
vulva as far as its hind extrem- 
ities, nothing can be done but 
to pull until the second calf 
also is extracted. Should it be 
possible to detect this abnor- 
mity within the uterus, division 
in some way or other may pos- 
sibly be acec.nplished. 

The thoracopagus (fig. 26) is 
a monstrosity consisting of two 
foetuses grown together at the 
xyphoid cartilage of the sternum 
and its neighborhood (aypho- 
pagus), or having a common 
thoracic cavity (sternopagus). 

It is often very difficult to 
diagnose it. In the beginning 
one always thinks to be dealing 
with twins. A close examina- 

Fig. 26.—Thoracopagus. tion only can ensure a diag- 

nosis. Any parts which have 
already entered the pelvic canal should be repelled in order to 
assure a thorough examination and allow us to make plans for 
extraction, respectively embryotomy. 

Treatment.—Total extraction can only be attempted in 
small foetuses, or when parturition takes place in the seventh 
or eighth month; while embryotomy must be resorted to in 
yoluminous monstrosities. No special directions can be given. 




















MONSTROSITIES 207 


In the xyphopagus, reduction with the chain saw might be 
tried; in the sternopagus, an attempt to remove a head, neck 
and fore legs is indicated. When this is followed by traction 
on the remaining head and fore limbs, extraction as far as the 
hind parts might succeed and further division or embry- 
otomy finish it. 

Polymelus.—Although this monstrosity does not, as a rule, 
cause dystokia, the supernumerary limbs might interfere with 
expulsion. With regard to the differential diagnosis, twins 
alone can be considered. Hmbryotomy in these cases is mostly 
crowned with success. 

Synkephalus and dipygus may give cause to difficulties in a 
posterior presentation, 


OBSTETRICAL OPERATIONS. 


Obstetrical operations are of great importance. The prac- 
tical application of the data contained in the previous chapters 
and the operative aid rendered in most cases by the obste- 
trician shall be discussed here. 

A thorough knowledge of topographical anatomy is in this 
instance just as essential as in operative surgery, among which 
the operations on the mother animal may be classed. Knowl- 
edge of the mechanism of parturition may form a valuable 
guide in the modus operandi. 

The operations on the foetus are either of a bloodless or 
bloody nature. To the former belong the diagnosis and repo- 
sition .of abnormal presentations; to the latter, partial and 
complete embryotomy. 


ir. 
OPERATIONS ON THE PARENT. 


1.—Vaginal Hysterotomy. 


Definition.—By lhysterotomia vaginalis is understood the 
foreible dilatation of the cervix uteri, by incisions into superior 
and lateral walls of the canal, which do not extend beyond the 
circular muscular layer. 

Topographical Anatomy.—The cervix uteri constitutes the 
most posterior portion of the uterus, and represents the con- 
nection between the body of the uterus (corpus uteri) and the 
vagina. In the vagina it appears as a round, free body, having 
a diameter of 4 cm., exhibiting many folds, and is termed the 
vaginal portion (portio vaginalis) of the uterus. The cervix is 
composed of three layers. The internal layer, a mucous mem- 

208 


VAGINAL HYSTEROTOMY 209 


brane, possesses many transverse folds, which secrete a viscid, 
opalescent slime during pregnancy, sealing hermetically the 
canal of the cervix uteri. 

The submucosa is rich in elastic and fibrous fibres, its 
lower portion having many veins and some arteries. 

The muscularis, lying between the mucosa and serosa, is 
. made up of concentric fibres, forming, so to speak, a sphincter 
muscle, and therefore designated sphincter cervicis. The outer 
muscular layer consists of longitudinal fibres, which are lost in 
the vagina. The external face shows a serosa, the peritoneum, 
which to some extent covers the vagina, reduplicates and lines 
the rectum. The excavation thus formed represents the so- 
called excavatio rectovaginalis. 

During dilatation of the cervix the canal is partly opened 
by the uterine contractions, gradually involving the cervix, 
partly by the mechanical action of the water-bag. This dila- 
tation is so considerable on account of the many elastic fibres 
and numerous folds of the palma plicata, that the corpus uteri 
and vagina form one wide canal for the passage of the foetus. 

Indications.—W hen the above described dilatation does not 
occur, the birth of the foetus stops. Many causes may produce 
insufficient dilatation. We have seen already that in many 
instances dilatation can be effected with the fingers or with the 
hand. It was also pointed out that many conditions may be 
mistaken for spasm of the cervix or obliteration of the cervical 
canal. Obliteration of the cervical canal is the only indication 
for hysterotomia vaginalis. It may be the result of a carti- 
laginous-like degeneration, from cicatricial tissue or adhesions 
between the walls of the cervical canal following injuries. In 
those cases conception took place at a time when the canal was 
still open and the wound not yet completely healed. The in- 
jury was received at a previous birth. 

Should the diagnosis be doubtful, mechanical dilatation 
must first be attempted. Forcible dilatations must remain the 
last resort. 

Details of the Operation.—Balestra already in 1816 per- 
formed vaginal hysterotomy in the cow. after the Richerand 


210 BOVINE OBSTETRICS 


method. Binz also mentions it in his obstetrical work, 1830, 
page 136. In cases where cartilaginous-like degeneration or 
extensive cicatricial tissue close the cervix uteri, an unfavor- 
able prognosis must be given. Iam of the opinion that the 
good results of many operators are partly due to the fact, that 
in those cases where operative interference was practiced, just 
as good results would have been obtained by a bloodless 
mechanical dilatation. The operation is performed as follows: 
The vagina is prepared by rinsing it with a 2 per cent. creolin 
solution; the hind legs of the cow are tied to prevent kicking 
the operator. It is preferable to operate the cow standing. 
Some prefer the recumbent position, as the os uteri is pushed 
further back and the operation is actually performed in the 
vagina; nevertheless, the standing posture is best. 

The bloody operation is executed by introducing a probe- 
pointed bistoury with the cutting edge upward as far as 
possible into the cervical canal. By pulling it backward and 
forward, the upper wall is incised. This is accompanied by a 
crackling sound. The incision penetrates the circular layer 
and is sufficiently deep when all resistance is overcome. Be- 
sides the upper incision, two lateral ones obliquely upward are 
made. 

It is not necessary to make more than three incisions. 
The parts are next explored to see whether the incisions 
extend sufficiently; when necessary, they are made longer. 
Should, as a result of violent pains, the os uteri protrude at the 
vulva, the sliding histoury may be used. <A very good instru- 
ment is also the adjustable herniotome. The hemorrhage 
during and after the operation is trifling. 

Further dilatation is effected by boring movements of the 
hand and fingers. Now patience becomes a virtue, and me- 
chanical dilatation is left to the water-bag. It is faulty to draw 
head and fore legs into the pelvic canal and exert traction im- 
mediately after the operation, as it may result in ruptures by 
which the abdominal cavity is opened. It is much better to 
wait for some time after the operation to apply but limited 
traction. 


ARTIFICIAL ABORTION PA li | 


Sequels.—A favorable termination may be anticipated when 
dilatation after the operation is completed by the water-bag 
and foetus. When during parturition much traction had to be 
employed and the parts torn, a favorable issue is still possible 
provided the serosa is intact and no communication with the 
abdominal cavity exists. It sometimes happens, in parturi- 
tions with incomplete dilatation, where head and legs never- 
theless enter the pelvic canal, that the portio vaginalis tears to 
pieces, when traction is exerted, without causing death: Lace- 
rations situated anteriorly are much more dangerous, as the 
circular muscular layer is much thinner in that region. It 
frequently happens that, following the operation, dilatation is 
insufficient, and that deep lacerations extending into the ab- 
dominal cavities result from traction. Unfavorable termination 
of the operation is due to septic peritonitis or a post-partum 
infection. The latter frequently occurs and can only be 
obviated by careful after-treatment, which should always be 
practiced in such animals. It consists in the early removal of 
the secundines, slight cauterization of the wounds and antiseptic 
irrigations. For cauterization, a 5 to 10 per cent. solution of 
zine chloride or lunar caustic is used; tincture of iodine may 
also be used. As an antiseptic, and at the same time astringent 
irrigation, a 2 per cent. alum solution renders excellent service. 


2.—Artificial Abortion.—Partus Prematurus 
Artificialis. 


In some cases it may be indicated to produce birth at a 
time when the foetus is not yet completely developed. Artificial 
abortion in the cow is not often practiced, and its sequels are 
often of a serious nature. 

Indications.—The diseased states indicating artificial abor- 
tion are: 

1. Dropsy of the Fetal Envelopes.—The time at which the 
operation should be performed for this condition depends on 
the intensity of the disease and general state of the parent; as 
a rule, the seventh or eighth month of pregnancy is selected. 


lb BOVINE OBSTETRICS 


2. Certain pelvic fractures ac juired during gestation and 
producing pelvic constriction on account of callus formation. 
Tn those cases where stenosis only decreases the pelvic dimen- 
sions about one-third, embryotomy is preferable to artificial 
abortion. The same refers to pregnancy in the very young 
female. 

3. Metrorrhagia, which is the result of placental hemorrhage 
during pregnancy. Violent uterine hemorrhages in the cow 
usually are caused by rupture of large blood vessels, so that 
our only means consists in artificial abortion and subsequent 
cc traction of the uterus; but in most cases artificial parturi- 
tion is too slow to save life. 

4. Great weakness of the mother toward the end of pregnancy 
in the seventh or eighth month, in consequence of which death 
of the parent and calf may be safely concluded should termina- 
tion of gestation be waited for. In such a case the calf is 
sacrificed to save the cow. 

5. Osteomalacia.—This treatment has occasionally yielded 
good results. 

6. Prolapsus vagine and dislocatio weri.—Prolapsus vagine 
in the second half of pregnancy may take such dimensions, and 
with the animal lying down the os uteri prctrudes beyond the 
yulva, and rupture of the uterus must be expected from the 
severe throes. This danger can usually be obviated by raising 
the hindquarters, by daily exercise and nutritious food and by 
administering agents quieting abdominal pressure. In serious 
cases, and in the last month of pregnancy, parturition may be 
produced artificially (St. Cyr and Violet). 

Procedure.—Many methods applied in human obstetrics 
are useless in the cow. The procedure consisting in mechani- 
eal dilatation of the cervical canal by boring movements with 
the oiled finger, gives no results, even when frequently re- 
peated. In the eighth month this method may give good 
results. 

One of the best means is the puncture of the foetal en- 
velopes and partial evacuation of the foetal waters ; but it has 
the disadvantage that the calf is born dead. As a rule, this 1s 


ARTIFICIAL ABORTION 213 


of no importance. The puncture is made with Charlier’s 
trocar through the cervix or right flank. When operating 
through the cervical canal, the finger is pushed forward as 
much as possible, the canula is introduced and the mem- 
branes punctured with the trocar. A thin catheter may also 
be used in the same manner to puncture the envelopes. The 
foetal waters flow off through the vagina. (Puncture through 
the right flank is only practiced in hydrallantois). 

Usually twelve to fourteen hours pass between evacuation 
of the foetal waters and manifestation of pains (Harms). 
Dolmer described a case where the cow only calved after eight 
days; 100 1. of liquid were discharged by puncturing the flank. 

The injection of warm water between the uterine mucosa 
and the chorion may be attempted to produce contractions of 
the uterus. 

The mechanical dilatation of the cervical canal by a pre- 
pared sponge is to be omitted, for fear of an infection. 

Pelzer recommends the injection of 150 g. of glycerine into 
the uterus to produce pains. This method has occasionally 
caused symptoms of intoxication in human obstetrics. 

The action of certain medicaments known as ecbolics, and 
administered with a view to produce abortion, is unreliable. 
We know that secale cornutum assists uterine contractions 
when already present, but does not produce them primarily. 
The same refers to sabina. But abortion may occur when 
toxic doses are given. Thomassen effected partus prematurus 
in a cow with hernia uteri by injecting subcutaneously 0.1 g. 
ergotin. 

Sequels.—When artificial abortion is finished, the placenta. 
must be expelled. In most cases the union between the 
maternal and foetal placents is quite firm and the uterine con- 
tractions weak. The conditions in the cow are unfavorable 
with regard to separation of the placenta; physiological 
expulsion is already much slower than in other domestic 
animals. 

Unless precautions are taken the secundines decompose, 
endangering the life of the animal. so that artificial abortion is. 


214 BOVINE OBSTETRICS 


in vain and may even terminate in death of the parent. Ra- 
tional treatment is required to prevent this. 

On the whole, the result of the operation is not very 
favorable in bovine practice, and is therefore rarely performed ; 
but in hydrallantois good results are obtained provided proper 
after-treatment is practiced. The latter, therefore, is of great 
wmportance. 


3.—Laparotomy. 


Definition.—Laparotomy is an operation in which the ab- 
dominal cavity is opened by incising the flank. In obstetrics 
it is usually performed as a part or first step of other oper- 
ations. 

Indications.—Laparotomy is indicated in torsio uteri after 
all other attempts to correct the abnormal position have failed. 
Tt may also be indicated in extra-uterine gravidity to remove the 
foetus, although this occurs rarely in obstetrical practice. It 
constitutes the first step of the Cxsarean section (sectio ceesared). 
At times it is performed to explore the cavity, when we suspect 
peritoneal abscesses as the result of a perimetritis. The cow 
being exposed to very little danger, justifies laparotomy as a 
diagnostic operation. : 

Procedure.—It is preferable to operate in the standing 
posture. In this way the danger of a possible eventration is 
much less; palpation also is much easier. The field of opera- 
tion is the right flank or the right lower abdominal region. 
That location depends to a great extent on the purpose lapar- 
otomy has in view. Thus, in torsio uteri, an incision made too 
high is extremely uncomfortable to the obstetrician who has 
to rotate the uterus, although there is less danger of an even- 
tration. Detorsion of the uterus is much easier when we 
operate in the right lower abdomimal region, but the chances 
for complications are greater. To avoid these difficulties the 
lower portion of the right flank should be selected as the field 
of operation. The same spot may be chosen to perform the 
Cesarean section. The explorative operation is made on the right 
upper flank. 


LAPAROTOMY 215 


Preparation.—When the cow is operated standing, she is 
pushed with the left side against some wall or partition and 
kept there by four assistants. In front of the right hind leg a 
long pole is driven obliquely into the ground, so that the lower 
portion of it is right under the right half of the udder, while 
the free end is pushed against the cow by an assistant to pre- 
vent her from stepping sideways and interfering with the 
operator. 

The hair is shaved from the external angle of the ilium to 
the last rib, and from the transverse processes of the lumbar 
vertebra as far as the region of the stifle. Now this’ part is 
brushed with soap and warm water and rinsed with a 2 per 
cent. solution of carbolice acid. All this is done by an assist- 
ant, and not the operator. 

The operator in between times washes the hands and 
cleans them mechanically, especially the finger-nails. It is 
much better to scrub them for a while with warm water and 
soap, than to dip them simply into an antiseptic bath. 

The necessary instruments, boiled before the operation, 
are: one bistoury, a pair of forceps, two artery forceps, a 
probe-pointed bistoury-, a pair of scissors, aseptic silk, needles, 
an Heister needle and thread to suture the skin. Some towels 
which have been lying in a 2 per cent. carbolic acid solution 
must also be on hand. 

With the convex bistoury the operator incises the skin of 
the right flank in the direction of the fibres of the internal ob- 
lique muscles to an extent of 15 em. The length of the wound 
in the Cesarean operation is 40 em. The incision begins 
4 inches from the external angle of the ilium and is made of 
sufficient length forward and downward with one stroke. The 
second cut severs the fibres of the external oblique muscles in 
the direction of the skin wound and crosses the fibres of the 
last named muscle. Now the internal oblique muscle is cut in 
the direction of its fibres, remembering that it grows thicker as 
we go up, and that the hemorrhage may be quite severe when 
branches of the circumflex iliac artery are cut. Finally, the 
transverse abdominal muscle and transverse fascia are severed, 


216 BOVINE OBSTETRICS 


leaving the abdominal cavity only closed by the peritoneum. 
A fold of the peritoneum is picked up with a forceps and 
incised ; further division is performed with the fingers. It is 
not advisable to perforate the peritoneum, as in this way it 
may be separated to quite some extent from the fascia trans- 
versa. 

In the operation on the standing cow no intestines enter 
the wound, but do so occasionally in the recumbent position. 
In such a case itis kept back with a towel by an assistant. 
Hemorrhage is controlled by torsion. 

After the operation, which was to succeed laparotomy as 
reposition of the uterus, metrotomy or the diagnostic explora- 
tion has been performed, the abdominal wall is sutured. 

Suture.—It is not necessary to suture the peritoneum or 
fascia transversa, but the abdominal muscles are to be firmly 
united. This is done with pretty strong silk by the continuous 
suture, bringing the stitches quite close together, puncturing 
each side about seven to eight times. (See Bayer’s Surgery, 
page 100). 

[Since the work is not accessible to the majority of English 
speaking veterinarians, any of the modern surgical works, as 
Moller’s, may be consulted.—W. | 

The beginning and end of the thread is secured, the knot 
is drawn into the lower corner of the wound and the thread cut 
off closely. The skin is stitched with the interrupted suture. 
For this purpose strong twine is used. About eight sutures 
are required. To secure firm union, Heister’s needle is used 
and introduced quite a distance from the edges of the 
wound. 

The neighborhood of the edge of the wound is now dressed 
with ung. cantharidum 1:3, carefully avoiding any soiling of 
the wound proper. Swelling, which soon follows, closes the 
wound and assists healing by first intention. When asepsis is 
practiced, healing soon occurs. An abdominal bandage in such 
an animal is not only unnecessary, but useless. It is im- 
possible to secure it, and its dislocation may interfere with the 
healing process. 


GASTRO-HYSTEROTOMIA yA Wy 


To prevent the wound from becoming covered with dust, 
or otherwise soiled, it may be covered with sublimat-glycerine- 
gelatine, an excellent agent, Sarpaseiine in this instance col- 
lodium or traumaticin. 

[Sublimat-glycerine-gelatine is prepared by taking a defi- 
nite amount of ordinary sheet gelatine. This is soaked in water 
containing 1 per cent. corrosive sublimate. After thoroughly 
soaking it, the mass is gently heated and 10 per cent. of gly- 
cerine is added. When needed, it is heated and applied in a 
thin layer with a brush.—W.] 

When the operation is performed aseptically, no further 
treatment is necessary. Although the silk is slowly resorbed, 
it does not produce suppuration. After about six days the 
wound forms a nice granulating streak, showing the silk here 
and there. This becomes imbedded and the wound is healed 
completely in fourteen days ; at that time union is so firm that 
the stitches may be removed from the skin. 

To prevent pressure against the wound by the intestines 
as much as possible, the cow’s hindquarters are elevated. 


4.—Ceesarean Section, Gastro-hysterotomia. 


Gastro-hysterotomy is an operation known for centuries, 
birth taking place by means of laparotomy and metrotomy. It 
is an operation endangering the life of the mother, although 
danger is to-day materially lessened on account of our knowl- 
edge of infectious agents and means to prevent them. 

Indications. —Czesarean section is not frequently performed 
in the cow. It is only indicated where the calf cannot be born 
naturally in spite of all attempts. When the foetus is access- 
ible to the hand, other methods are usually employed to 
deliver it; for instance, embryotomy, an operation much less 
dangerous when rationally performed. Only in obliteration of 
the cervical canal, where vaginal hysterotomy has failed, and 
in torsio uteri, which could not be reduced even by a lapar- 
otomy, may it be indicated (Albert). This operation is not 


218 BOVINE OBSTETRICS 


justified when the parturient passages are normal and the foetus 
absolutely too large. 

Tn most cases the owner prefers to slaughter the animal, 
especially when other manipulations have been practiced. 
The chance for a successful issue is still more limited when 
hysterotomia vaginalis or laparotomy have been performed, 
and in the latter manual detorsion of the uterus has been 
attempted. 

Nevertheless, the Cxsarean section can be executed, and 
when artfully performed may be crowned with success, should 
the owner be anxious to save a valuable animal. This is 
proven by numerous communications in veterinary literature. 

Procedure-—The standing posture of the animal is best 
adapted for the operation. In many cases this is impossible, 
and we must operate the cow in the recumbent position. She 
is placed upon the left side and the posterior extremities are 
raised. 

Before operating, the fore and hind legs are tied sep- 
arately and poles are driven into the ground, one in front of 
the hock joint, the other behind the carpus, protecting the 
surgeon and enabling him to operate on the abdominal wall. 
Four assistants, one to the head, one at the tail, and two at the 
back, hold the cow in place. 

The hair is shaved over an area much greater than the in- 
cision, the skin is scrubbed with soap and warm water, and 
finally with a 2 per cent. carbolic acid solution, Aither or 
chloroform may be given should a sufficient number of assist 
ants be present. The field of operation lies in the right lower 
abdominal region; in other words, where the calf can be plainly 
felt. The higher the operation is performed the less the 
danger of a future eventration, but it is much more difficult to 
withdraw the uterus and its contents. 

We only operate in the linea alba when the parent is to be 
slaughtered and the calf only is to be saved. Should we wish 
to keep the mother alive, this operation is not justifiable, for 
various reasons. The incision through the udder, the pressure 
of the intestines upon the stitches in the abdominal walls, the 


GASTRO-HYSTEROTFOMIA 219 


limited powers of regeneration of the elastic fibrous tissue, are 
important factors. 

The cut through the skin is made from above and behind 
to before and below, in the direction of an imaginary lins 
drawn from the external angle of the ilium to right fore claw. 
Some (Albert) make a perpendicular incision through the right 
lower flank. The length of the incision is about 40 cm. The 
abdominal wall is split in the same way as in laparotomy (see 
page 215). Now the most important part of the operation— 
metrotomy—begins. 

First the hand acquaints itself in the abdominal cavity 
with the position of the calf. As a rule, its hindquarters lie 
close to the wound, it being the most favorable position for 
extraction. That part of the gravid horn turned toward the 
diaphragm is drawn with the hind extremity of the calf into 
the wound, or if possible outside the belly, upon an aseptic 
cloth resting against the edge of the wound. This manipula- 
tion is difficult, but itis much better to proceed in this way 
than to incise the uterus in case it remains in situ. 

The horn, which has been pulled outside the wound, 
presses upon the edges of the wound, so that any hemorrhage 
is immediately stopped and the complete occlusion prevents 
entrance of air and eventration. 

Metrotomy is performed outside the abdominal cavity to 
stop the foetal waters or uterine secretions from running into 
the peritoneal sac. The uterus is incised in the long direction 
of the gravid cornu. The dimension of the cut cannot be given 
with certainty, since it depends on the size of the foetus. It 
must be sufficiently large to allow the calf to pass without 
tearing the edges of the wound. 

As a rule, the incision extends beyond the mucosa into the 
chorion; as a result of this the allantoic fluid is discharged. 
The chorion is now torn by hand and the calf quickly extracted. 

The edges of the uterine wound must be fixed by assist- 
ants in order to prevent retraction of the incised womb by the 
uterine contractions and soiling of the peritoneum. Of course 
it is understood that the assistants have clean hands and 


220 BOVINE OBSTETRICS 


towels and have been previously instructed. The secundines 
are detached from the placentze materne and removed. The 
uterus, which has contracted still more during this time, is 
wiped clean with a towel, thus removing the uterine milk and 
remains of the foetal waters. All this and the suturing is done 
external to the abdominal cavity. 

Uterine Suture.—This must be made with the greatest care 
to prevent the uterine secretion from passing through the 
wound into the abdominal cavity. 

The contraction of the uterus favors the closing of the 
wound, reducing it about one-half in a few hours after the 
operation. Cat gut is used as suture, practicing Lembert’s 
method. In order to strengthen the suture, the wound is first 
thoroughly stitched, bringing the edges into close opposition. 
Then Lembert’s suture through serosa and muscularis is put 
in, inverting at the same time the first stitches. In this manner 
firm union is assured. Now the sutures are dried and the 
uterus replaced. 

The abdominal wound is closed in the same manner as in 
laparotomy. 

A fter-treatment.—When a Cesarean section is artfully per- 
formed, no further treatment is necessary; only certain com- 
plications are to be avoided. For the first few days the food 
must not be voluminous. 

The upper portion of the wound usually heals more kindly 
than the lower one. Occasionally necrotic tissue is found in 
the wound after five to six days. It is to be removed and the 
wound treated on general surgical principles. 

Course of Operation.—Should healing by first intention 
take place, union of the uterine wound occurs in eight to ten 
days. The portion projecting into the lumen of the uterus 
undergoes fatty degeneration; later it disappears entirely. 
The localized peritonitis about the uterine wound assists in 
the union of the serous membranes and does not lead to 
adhesions, 

The involution of the uterus takes place rapidly, the 
uterus obtaining its normal form in due time. No rise of tem- 


DIAGNOSIS AND CORRECTION OF MALPOSITIONS 221 


perature follows the operation when healing proceeds as just 
described. In some cases peritonitis follows the operation, 
either as a result of soiling by the uterine secretions or foetal 
waters, and through infection during the operation by the 
operator or his assistants. Peritonitis is very liable to set in 
when eventration of the intestines occurs. At the same time 
it is not necessarily fatal, although a doubtful prognosis should 
be made. Peritonitis may produce extensive exudation and 
later adhesions, leading to a subacute or even chronic course. 


FT. 
REPOSITIONS AND OPERATIONS ON THE FETUS. 


1.—Diagnosis and Correction of Malpositions. 


Definition.—Abnormal position. 

Iu the normal presentation the anterior extremities—that 
is, the head resting upon the fore legs, or both hind legs—lie 
in the parturient passage. In both of these positions the 
belly of the calf is opposite to the abdomen of the cow. Such 
a presentation is known as the abdominal position. 

Any position deviating from the above isabnormal. While 
interfering frequently with birth, it need not necessarily be- 
come a cause of dystokia. The possibility exists that the calf 
may be born without assistance in spite of an abnormal posi- 
tion when the cow’s pelvis is wide and the foetus small. 


THE ART OF REPOSITION. 


The art of reposition deals with the abnormal positions 
and indicates their correction. Therefore we shall discuss 
successively : the measures to be taken by the obstetrician for 
his own or the cow’s sake, the diagnosis of abnormal presenta- 
tions, and the rules applicable to each case. 

A precaution exercised by the obstetrician consists in the 
proper choice of clothing while at work. A veterinarian must 
not be afraid to soil his clothing, and should not wear expen- 


3292: BOVINE OBSTETRICS 


sive clothing when practicing obstetrics. Many suggest the 
mere removal of the coat and tucking up of the sleeves. This 
is impractical and insufficient, as the underwear bulges at the 
upper arm, thus interfering with the introduction of the arm 
and exploration. At the same time it is apt to slip and become 
wet. It is best to wear a flannel shirt and another one with- 
out sleeves; further, an ordinary vest, when necessary, over it, 
a sleeveless blouse, and a pair of old breeches. Some use 
knee pads, consisting of leather, with buckle and strap. They 
are fastened about the knee in the same manner as knee pads 
on the horse. These knee pads are very nice, preventing the 
knees from getting wet, especially for veterinarians who are 
called on to do obstetrical work while attending to their regular 
route. 

The dangers to which the obstetrician is exposed are 
either direct or indirect ones, as kicking or falling of the ani- 
mal, or infections. 

It is rarely necessary to secure the cow; an assistant 
holds the tail and pays attention that the arm of the veteri- 
narian is not soiled by feces. Should it be necessary to put 
the cow on her back, the fore and hind legs are fastened sepa- 
rately and held by assistants. 

When an exploration is made on the standing cow, we 
must keep an eye on her constantly, to prevent fracture of the 
arm as she suddenly drops. 

The infection which frequently threatens the obstetrician 
consists of a pustulous exanthema of the arms and hands. 
Some people are especially susceptible to it. It is often seen 
after delivering a decomposing foetus, a so-called emphysema- 
tous calf, although the obstetrician may become infected by 
dead and not yet decomposing foetus (Plessow). Experience 
teaches that no immunization occurs after recoyery from the 
infection, but that it increases susceptibility. 

Symptoms.—About ten to sixteen hours after delivering 
the calf, the arm and hand begin to itch, usually first below 
the ulna. On close examination many little spots of pin-head 
size are observed, especially where the hair is. The itching 


DIAGNOSIS AND CORRECTION OF MALPOSITIONS 223 


sensation increases, the red spot reaching a diameter of } to 2 
cm. on the second and third days; frequently the axillary 
glands swell. During the first two days the red spots increase 
in number. The first spots feel more or less hard, the redness 
being diffused. On the third day the color changes in the 
centre and a little vesicle with serous contents develops, to 
become purulent on the fourth day, seen by the white ring in 
the central red elevation. During this time itching has been 
pronounced, so that the patient must force himself not to dis- 
turb the normal course by rubbing. 

On the fifth day the epidermis contracts hyperzemia and 
itching diminishes. 

On the sixth day slight exfoliation takes place, the process 
coming to an end in a few more days. 

Many deviations from the course are observed. Plesson 
states that the primary red points-increase in size and extent 
up to the sixth day. Chills and insomnia set in, new abscesses 
forming constantly, not only in the region of the old ones, but 
also in new places. This existed for three months, when 
recovery took place. 

As a rule, the infection is of a local character, does not 
disturb general health, and terminates in a few days. 

Prophylaxis.—The infection seems to occur in numerous 
places through abrasions. Embryotomy favors it, especially 
as the epidermis is injured here and there, allowing entrance 
of infectious material. Each pustule represents a local infec- 
tion. By simply washing with cold water, low organisms with 
their media (foetal waters, soft parts of the calf, placenta) 
remain behind in invisible quantity on the parts denuded of 
epidermis. 

These organisms are readily concealed on hairy parts, 
and can only be removed by a thorough cleaning (Hohmann). 
The prophylaxis consists in covering any small wound with 
iodoform-collodium before the operation. Arms and hands 
are dressed with 5 per cent. carbolized oil, to be cleansed me- 
chanically after parturition is effected. The latter is best done 
by scrubbing them with soap and warm water (Klaeber), fol- 


224 BOVINE OBSTETRICS 


lowed by a wash of bichloride of mercury solution 1-1000, or a 
2 per cent. creolin solution. 

Veterinarians not dressed for the occasion frequently soil 
the sleeves with blood and foetal waters. After disinfecting 
hands and arms the dirty sleeve is pulled down, thus offering 
an excellent opportunity for infection. Under such circum- 
stances the underwear must be changed and the arms and 
hands disinfected again on their arrival at home. 

When infection has once taken place, it is advisable to 
apply bandages saturated with a 1 per cent. corrosive subli- 
mate solution to the arms and to keep them wet with the 
solution. Of course, it is understood that a physician is con- 
sulted. Infection may also occur after delivery, as the follow- 
ing instance shows: 

In November, 1892, I was requested by the butcher 
J at Z to deliver a double-ender in a two-year-old heifer. 
The foetus was absolutely too large and the pelvis constricted 
laterally. Complete embryotomy was performed. The various 
parts of the calf weighed altogether 60 kg. On my arrival the 
calf was still alive, but was sacrificed to save the cow. 

After completing the work, the owner brought a bucket of 
water to wash in. Two assistants and myself cleaned our arms 
and hands with soap and this water. A third assistant, who 
could not wait, washed himself at a neighbor’s. The following 
day a pustulous exanthema, as described, developed on myself 
and those two assistants who washed themselves with the 
water out of the bucket. The third assistant, who assisted 
mainly in embryotomy, was not attacked. 

In all probability infection occurred while washing our- 
selves. It was discovered later that the bucket which served 
as a wash basin was used to collect intestines not yet cleaned. 
This water was full of low pathogenic organisms, causing the 
local infection. The pustulous exanthema disappeared in about 
six days. The cow was not the least disturbed from this diffi- 
cult parturition. 

Care of the Animal.—The owner of an animal requests 
veterinary service to save an animal. He has confidence in 


DIAGNOSIS AND CORRECTION OF MALPOSITIONS 225 


our knowledge, and can demand that all means known to 
science be applied. The obstetrician, therefore, is in duty 
bound to omit nothing which may hasten or bring about a 
favorable termination. 

The first point to be observed is sufficient room and light. 
When no room exists we must do the best we can, but when 
present, there is no excuse for working in a limited space be- 
tween other animals. The cow is taken to another place, or, 
should this be impossible, the adjoining cows are to be 
removed. While the owner may not like such changes at first, 
he will soon see that the treatment in this way is assisted and 
made easier. 

The attention of the beginner must be drawn to the fact 
that practical actions and plodding in the dirt are not alike, 
but that he is practical who uses the means within his reach 
properly and artfully. Since most births occur in the evening 
or at night, care should be taken to provide sufficient light. It 
is foolish to say that light is a secondary consideration, since 
parturition takes place in the dark anyway. The obstetrician 
must see the whole animal and prevent, if necessary, an event- 
ual tympanitis, by straightening the cow and overlooking his 
assistants. 

Straw or hay, ete., must be handy in sufficient quantities 
to make a soft bedding. Elevation of the hindquarters of the 
cow assists greatly inthe work. The obstetrician may carry in- 
fection from one cow to the other. This is done by hands and 
arms insufficiently cleansed, or shirt sleeves soiled at a previous 
case, but also by ropes and instruments. The obstetrician 
may also infect a cow when previously engaged in the removal 
of an emphysematous foetus and decomposing secundines, 
without taking the necessary precautions. 

Diagnosis of the Abnormal Position.—A correct diagnosis is 
half the reposition. When this is duly considered, matters are 
less difficult than they appear to be. While it often requires 
great pains to recognize the position of the calf, no doubt in 
regard to it should exist. When matters are left to chance, 
disappointments are apt to follow. Only after a thorough 


226 BOVINE OBSTETRICS 


diagnosis has been made, can we form plans for reposition, 
which may then be executed with confidence. Without a firm 
diagnosis the obstetrician is at a loss, and loses the necessary 
self-confidence. 

The general rules of the art of reposition must be apphed 
in each case. By it the correction of an abnormal presentation 
is simplified; their omission may render reposition impossible. 
The first condition to remedy a malposition is room for manip- 
ulations. It can only be obtained in the uterus when not con- 
tracted. When head or legs in abnormal position have passed 
the pelvic inlet, they must be repelled. 

Should the uterus mould itself on the calf, as it occurs 
when the foetal waters have been discharged, it must be 
replaced by introducing warm water into the uterus. The 
warm water, which should be of the temperature of the body 
(Franck recommended it already in 1876), or a 1 per cent. 
ereolin solution, is introduced by means of rubber tubing and 
a funnel. J. G. Eberhard, as early as 1793, suggested slimy 
decoctions for this purpose. 

The correction of a faulty position is greatly assisted by 
the liquid, as the uterus is less contracted and, therefore, in- 
terferes less with the operation. 

Many obstetricians are in the habit of fixing temporarily 
all parts of the body which lie in the pelvic canal, by means of 
a cord, in order to draw them later into the parturient passage 
when necessary. It will be of advantage to the beginner to 
practice this method, while the experienced man need not 
necessarily follow it. 

In certain cases, especially when portions of the calf have 
been driven into the pelvic canal by strong pains, it is advisa- 
ble to practice reposition on the standing cow. This affords 
more room and often assists in defining the existing conditions. 
Should reposition be practiced in the recumbent position, it is 
best to place the animal upon its right side, or in a straight 
position upon the knees. In this way tympanitis, setting in at 
times during parturition, can be obviated. Sometimes it is 
indicated to place the cow upon the left side or in a dorsal 


DIAGNOSIS AND CORRECTION OF MALPOSITIONS 227 


position in order to reach the head or flexed legs. An animal 
may be placed into any position should it further the purpose ; 
but the cow cannot endure the dorsal position very long, and 
contusions of the sacro-iliac articulation may follow strong 
traction in this position. 

To correct an abnormal position the hand is principally 
used, and the use of instruments should be deferred as long 
as possible. In most instances reposition by hand is possible, 
and the parts in the parturient passage can be secured after 
reposition. With practice, decided dexterity is acquired, and 
disagreeable complications are less liable to follow birth. 
Cords are often necessary; hooks, porte-cords, etc., can be 
often dispensed with. 





Figs. 27 and 27a. 


Instruments Used in Repositions.—Of the many obstetrical 
instruments, to which new ones are constantly added, only a 
small number are of use. Although the discussion shall touch 
upon many useless instruments, a description of the various 
mechanical means is indicated. 

One of the most useful agents is hemp-rope, usually 2 m. 
Jong and 7 mm. in diameter. A loop is on the one end, the other 
one being wrapped with string to prevent its unraveling. Thin 
cords hold better, but soon cut the parts. Thin cords, of 
course, may be doubled and a doubled noose be made (figs. 27 
and 27a). 

Many obstetricians prefer for the head and legs a web 
3 cm. wide and 2 m. long, or a band. They have the advan- 
tage of being more pliable; do not slip and cut. 


228 BOVINE OBSTETRICS 


Parts of the Body which are Corded.—When the fore or hind 
legs lie in the pelvic canal they are usually corded above the 
fetlocks, especially when strong traction must be exerted. No 
foetal membranes should be caught between the rope and the 
parts corded. When the head is to be fixed the loop is placed 
around the lower jaw, or the rope without a noose is run around 
the whole head behind the ears. In the latter instance the 
middle of the rope is pushed over the skull behind the ears by 
means of the tips of the fingers. Now the two free ends 
beneath the lower jaw are twisted until the rope no longer 
slips off when pulled at. This cord is more readily applied 
than the head stall constructed by Binz, Schaack and Rueff. 
A loop is only then placed around the upper jaw when it is 
desirable to pull the head backward in the direction of the 
skull, otherwise the loop slips off. In the normal presenta- 











Fig. 28.—Binz’s Repeller. 


tion, extraction may be practiced by placing the cords above 
the carpi or hocks. In those stables where but little room is 
found behind the cows, so that the assistants soon touch the 
wall with their backs, such ropes are of service. 

Tn order to exert force, round sticks, 830 em. long and of a 
diameter of 4 cm. in the middle and 8 em. on their ends, are 
fastened to the ropes. The free end of the cord is placed 
around the middle of the stick with a surgical loop. The coni- 
cal shape of this stick renders the removal of the rope easy. 

To repel the calf comfortably, Binz constructed a wooden 
instrument, which he terms goblet-repeller (Stossbecher) 
(fig. 28). It is used when the head is already in the vagina 
and the fore legs still in the uterus. The goblet is placed over 
the nose of the calf, the crutch against the breast or shoulder 
of the operator. 


DIAGNOSIS AND CORRECTION OF MALPOSITIONS 229 


Although the instrument can be used occasionally to ad- 
vantage, itis better to replace it by the hand. Retropulsion 
of the calf is aided materially by placing the hindquarters of 
the cow into an elevated position, or, if possible, inducing the 
cow to stand up. When the feet are braced well, the hand, 
resting upon the forehead or nose of the calf, can exert just as 
much force as the goblet-repeller. Gunther had an instrument 





Fig. 29.—Repeller. 


made for the same purpose, termed by him “obstetrical 
crutch.” It consists of an iron cylinder 75 cm. long, having on 
the one end a concave cross-piece and a handle on the other. 
It is used by placing it against the cervical portion of the 
sternum and the calf repelled; while doing so the hand must 
always accompany the instrument. The calf may also be re- 
pelled by Gunther's crutch when in the posterior presentation ; 
that is, the buttock toward the pelvic inlet; in such a case it is 
placed against the postero-external angles of the ischium. 





Fig. 30.—Trager’s Wire Loop. 


An instrument of similar construction is that crutch es- 
pecially used for retropulsion in the posterior presentation 
(fig. 29). The rod of this instrument has a concave transverse 
piece with a spike; the latter is introduced into the arms. 

Trager had a wire loop made of brass, mainly to fix the 
head when flexed backward. The above cut (fig. 30) gives an 
idea of the instrument. In order to secure displaced parts, 
which cannot be reached with the cord, so-called porte-cords 
have been constructed. Gunther’s porte-cord (fig. 31) consists 
of two iron rods placed upon each other, 78 em. long. The 
upper one is provided with a handle and ring, so that the 


230 BOVINE OBSTETRICS 


lower one can be pushed to and fro. Two jaws, the lower one 
of which is movable, and which can be closed by pushing the 
rod ahead, are found on the one end. The noose is now 
placed between the jaws of the instrument andintroduced. It 
proved itself useless in practice. Already in 1793 Eberhard 








Fig. 31.—Gunther’s Porte-cord. 


had made for the same purpose a turning stick (Kehrstock). 
This instrument consists of a whale-bone with a knob of ivory 
on the one end; a vertical groove in the knob receives the rope 
or web. 

Binz’s obstetrical probe (fig. 32) is a flat, curved stick, 45 
em. in length, with an eye in the curved end. It is mainly 
used to cord the head when deviating backward, or the legs 























Fig. 32.—Obstetrical Sound. 


when incompletely extended. The rope or noose is run 
through the eye, and carried behind and around the retained 
part, until the loop can be grasped with the hand and the in- 
strument retracted. 

Giinther’s long hook (fig. 33) is used in the same way as 
the porte-cord. 





Fig. 33.—Gunther’s Curved Porte-cord. 


Darreau’s porte-cord (figs. 34 and 34q) is 80 to 85 em. long, 
the rod having a diameter of 6 to 7 mm. 

Binz, Schaack, Rueff constructed porte-cords to secure the 
head, which can be dispensed with in practice. 


DIAGNOSIS AND CORRECTION OF MALPOSITIONS 231 


To correct deviations, hooks may be used. In the living 
calf blunt ones only are used in case of necessity. Should the 
foetus be dead, sharp hooks may be employed. 

In the dead calf hooks are especialiy used to secure the 
displaced head, by inverting them into the internal canthus of 
the eye. Such hooks may also be fastened in the inferior 
maxilla and ligamentum nuche. When placed into the 








Figs. 34 and 34a.—Darreau’s Porte-cord. 


ear, septum nasi or skin hooks usually tear out. In the pos- 
terior presentation in a dead calf they may be passed through 
the rectum into the oval foramen or in front of the symphysis. 
Blunt hooks are preferable. There are two kinds of hooks, 
short and long ones. The former are 12 em. long, with an eye 
3 cm. in diameter at the one end; the width at the curved por- 
tion is 3 em. A rope with a loop is run through the eye, which 
is used for traction (fig. 35). 

The curved portion of the hook is covered with the index 
finger when introducing it. 





Fig. 35. Fig. 36. Fig. 37. 
Obstetrical Hooks. 


The long hook has a length of 60 cm., and on the end a 
handle or crutch. 

Tn order to fix the head a double hook may be used. It 
consists of two separate hooks inserted into the orbital cavi- 
ties. A rope is passed through the rings of each hook to 
retain them in place and to permit of traction. 

Vogel constructed an iron, nickel-plated double hook on 
the principle of Reimer’s hook, being 12 cm. long, and its seg- 


232 BOVINE OBSTETRICS 


ment 5.4 cm. wide. These hooks, closing in the same way as a 
forceps, do not injure the uterine walls. It is Vogel’s opinion 
that they can be used to draw forward limbs retained in the 
uterus, to extract a fully developed dead foetus, to remove in- 
accessible parts after embryotomy, ete. 

The plain hook of Vogel is provided with a hinge and 
spring in the curved portion of the hook, so that the point 
of the hook can be held in the hand (fig. 36). 

A very useful instrument is Obermayer’s hook, its segment 
having a width of 4.5 em. (fig. 37). 






Fig. 38.—Kaiser’s Double Borer. 


Kaiser constructed a double auger to adjust misdirected 
parts of a dead foetus (fig. 38). The double end, shaped like a 
corkscrew, is bored into the skin or parts below and can be 
retracted into the canula. 


2.—Classification of Abnormal Presentations. 


The longitudinal presentation was previously termed a 
normal presentation, and represents a position in which the 
long axis of the foetus runs parallel with the long axis of the 
mother. It must be at the same time an abdominal position— 
that is, the abdomen of the calf lies opposite to the belly of the 
mother. In this position the head, resting upon the fore legs, 
as well as the hind legs, may enter the parturient passage. We 
look upon both as normal. In either case the conditions for 
the passage of the foetus are very favorable, and parturition 
usually takes place without assistance. Any deviation from 
that position interferes with expulsion, as the dimensions of 
the calf do not correspond with those of the pelvis of the cow. 

The obstetrician then attempts to correct the presentation, 
in order to aid the passage of the calf through the pelvic 
canal. 


CLASSIFICATION OF ABNORMAL PRESENTATIONS 233 


RESTORATION OF THE NORMAL PRESENTATION. 


In the following I give a synopsis of the abnormal presen- 
tations. 

Usually two main groups are recognized: the longitudinal 
and transverse presentations. The vertical presentation was 
already discussed under anteversion. 


I. LonerrupinaL PRESENTATION. 
1. Abdominal position. 


(a) Abnormal position of one fore leg. 
Fore leg with the poe carpus ¢ against the symphysis. 
x x «“ in the pelvic canal. 
Fore leg bent back under the body, the shoulder 
against the symphysis. 
Fore leg bent back under the body, the shoulder in 
the pelvic canal. 


(b) Abnormal position of both fore legs. 
Both fore limbs as under a. 


(c) Abnormal position of the head. 
The head resting against the shoulder. 
ce 6é cc ce oc thorax. 
« « descended between the fore legs. 
«  « deviated upward and backward. 


(d@) Abnormal position of head and fore legs. 


(e) Abnormal position of one hind leg. 
One hind leg flexed, fetlock under or against symphysis. 
One hind leg flexed, fetlock in the pelvic canal. 
One hind leg entirely retained. 
(f) Abnormal position of both lind legs. 
Both hind legs as under e. 


2. Costal Position.—The thoracic wall of the calf is turned 
toward the abdomen of the cow, the fore or hind limbs 
with eventual deviations lie in front or in the pels 
inlet. 


234 BOVINE OBSTETRICS 


8 Dorsal Position.—The back of the calf is turned toward the 
belly of the mother, the anterior or posterior extremi- 
ties occupy the parturient passage, offering some of the 
above deviations. 


II. TRANSVERSE PRESENTATION. 


The abdomen or back of the calf in this presentation lies 
toward the pelvic inlet. For this reason an abdominal 
transverse presentation and a dorsal transverse pre- 
sentation are recognized. 

In the former the abdomen is opposite to the inlet ; 
in the latter the back of the calf presents itself trans- 
versely in front of the pelvic inlet. 

In the abdominal transverse presentation, one or 
more legs may enter the pelvic canal, sometimes all 
four legs; should the head also enter, the hindquarters 
descend on account of its weight, and the transverse 
presentation changes into the longitudinal presenta- 
tion, in consequence of which the hind limbs and an- 
terior extremities lie in the so-called dog-sitting 
position (Harms). 


L—LONGITUDINAL PRESENTATION, 


1.—ABDOMINAL POSITION. 


(@) ABNORMAL POSITION OF ONE FORE LEG. 
The fore legs with the flewed carpus against the symphysis. 


Causes.—Insufficient dilatation of the cervix uteri and 
early rupture of the water-bag. Traction by the attendant 
while exploring on the normally presented fore leg before com- 
plete rotation of the calf took place. 

Diagnosis.—On exploration the normally presented fore leg 
and head are recognized in the pelvic canal; the bent knee lies 
opposite the pelvi¢e inlet or below it. By gliding downward 
along the flexed limb, the fetlock and claws are felt. When 


CLASSIFICATION OF ABNORMAL PSESENTATIONS 235 


the greater part of the foetal waters is discharged, the uterus is 
firmly contracted upon the calf. 

Prognosis.—Favorable. 

Treatment.—Passing the hand into the uterus, the opened 
hand is placed against the skull, thumb and fingers to either 
side, and the calf is pushed back. If possible, the cow is 
standing, the calf then slips back itself. To adjust the retained 
leg the hand grasps the shin-bone and pushes the bent knee 
upward. Now the hand glides downward, takes hold of the 
claws and draws the limb into the pelvic canal (fig. 39). 





Fig. 39.—Abnormal Position of One Fore Leg. 


Should this method fail, a loop is placed below the fet- 
lock. Now, while repelling the calf by hand, the leg is pulled 
gently into the parturient passage. In those cases where the 
fetlock of the retained leg can be corded, reposition by hand is 
usually possible. 


The fore leg bent at the carpus and in the pelvic canal. 
(Pelvic knee presentation, Harms.) 


Causes.—The causes are the same as those in the last pre- 
sentation. As a rule, the expelling powers have been here 
more successful, as the foetus was small or the pelvis more 


236 BOVINE OBSTETRICS 


roomy. This presentation often succeeds the last named one, 
when the owner has exerted severe traction on one fore limb 
or head. 

Diagnosis.—The fore leg lying in a normal position has 
been drawn as far as the vulva or into it. The head rests in 
the pelvic canal. The other leg, doubled up, is felt on the 
side of the pelvic passage ; the radius is directed backward 
while the metacarpal bone rests upon the floor of the pelvis. 
The leg is wedged tightly, so that it is often difficult, at times 
impossible, to reach the claw of the flexed leg. 

Prognosis.—On the whole, it is favorable, but there is 
danger of injuring the floor of the vagina. 

Treatment.—The calf must be repelled. Should the foetal 
waters have been entirely evacuated, infusions of warm water 
may be employed. Following retropulsion, reposition may be 
attempted. Occasionally the carpus has advanced so far, that 
it is closer to the pelvie outlet than inlet. It does not occur 
with laterally constricted, respectively juvenile, pelvis. Here 
retropulsion is more risky, on account of rupturing the roof of 
the vagina, than extraction. In such a case a thin loop is 
placed around the inferior extremity of the radius, and the calf 
is extracted in the direction of the sacrum. Severe traction 
must not be exerted, and only two men are allowed to pull. 

Should the foetus be dead, the chain saw is placed around 
the knee and the joint eut through. The lower portion of the 
leg is then removed with the hand. A thin rope is next placed 
around the lower extremity of the radius, and traction prac- 
ticed. The sawed part is covered by the hand during extraction 
to protect the vaginal wall against injury. In case no chain 
saw is handy, a thin, tough iron wire will replace it, used 
exactly as the saw to cut the skin and joint. 

The fore leg bent back under the body, the shoulder against the 
symphysis. 
(Unilateral shoulder presentation, Harms.) 


Causes.—This abnormal position arises when the head 
enters the pelvic inlet before rotation of the calf takes place. 


CLASSIFICATION OF ABNORMAL PRESENTATIONS Dau 


Also during incomplete dilatation, when the owner pulls on 
that fore leg which is in a normal position, while the other lies 
with the carpus against the symphysis. 

Diagnosis.— Head and fore leg lie in the pelvic canal, but 
have more advanced than in the carpal presentation. By glid- 
ing the hand along the head and neck, the scapular spine, below 
it the elbow joint, and the radius extending backwards, is de- 
tected. As a rule, the claws of the retained limb can be 
reached. 

Prognosis.—Favorable. 

Treatment.—Small calves, such as twins, can be extracted 
in this abnormal presentation; but the diagnosis must be posi- 
tive before it is attempted. Large calves are not to be 
extracted, nor is birth possible with a constricted pelvis. 

Extraction is performed by pulling on the head and the 
fore leg in the pelvic canal at the same time. Nevertheless, it 
is better to adjust the malposition. This is quite easily done 
in small and living calves. The manipulations to correct the 
faulty state are as follows: The hand grasps the shin-bone with 
the thumb resting on the anterior face of the bone, the carpus 
is flexed toward the symphysis; while the carpus is pushed 
upward the calf is repelled, the hand glides downward, seizes 
the claws and draws the leg into the pelvic canal. 

Should this method fail, the fetlock may be corded. By 
repelling the calf with one hand the leg is slowly carried into 
the parturient passage. When the calves are very voluminous, 
in double-enders, emphysematous calves, the uterus may con- 
tract to such an extent that neither retropulsion nor reposition 
are possible. 

Under such circumstances infusions with warm water, fol- 
lowed by reposition, are tried. Should this also fail, we resort 
to embryotomy, removing subcutaneously the fore leg lying in 
the pelvic canal. After this reposition of the retained leg is 
usually possible. When necessary, partial embryotomy can 
be continued, removing the head, neck and even the retained 
limb at the shoulder. 


238 BOVINE OBSTETRICS 


The fore leg bent back under the abdomen, the shoulder in the pelvie 
canal. 


In this instance parturition has further advanced, be it on 
account of stronger uterine contractions or because the owner 
pulled on the presenting parts. 

Diagnosis.—The head and one fore leg are well forward in 
the pelvic canal, one-half of the metacarpal bone of the ante- 
rior limb lying normally projects from the vulva, the nose is 
visible between the labiz. On exploring the side where the 
leg is bent backward, the shoulder is felt in the pelvic inlet. 
The parts resting in the vagina are often wedged. 

Prognosis. —F avorable. 

Treatment.—When the calf is small and the pelvic canal 
normal, as is usually the case in cows which have calyed re- 
peatedly, extraction is possible in this abnormal position. 
Traction is then exerted on the head and the fore leg present- 
ing itself normally. Should the calf be alive, reposition is 
attempted by retropulsion, thus changing this presentation 
into the preceding one. But when severe traction has been 
practiced by the owner, wedging and killing the calf, when the 
uterus has finally contracted so that repulsion appears impos- 
sible, embryotomy must be performed. In these cases partial 
embryotomy is mostly sufficient and more advisable than 
forcible extraction. 


(b) ABNORMAL POSITION OF BOTH FORE LEGS. 


The treatment is the same as given under reposition of one 
fore limb. One must not omit to immediately cord the ad- 
justed leg, before correcting other abnormalities. 

Special discussion is required in case both fore legs are bent 
backward under the abdomen. 

The causes are insufficient dilatations of the cervix uteri, 
feeble pains and thus slow rotation of the calf. This abnormal 
presentation is often met with in partus prematurus at the 
seventh month. 

Diagnosis.—The head has progressed as far as or beyond 
the vulva, its ears being visible between the labiw. On explora- 


CLASSIFICATION OF ABNORMAL PRESENTATIONS 239 


tion, gliding along the neck, both shoulder blades are found 
within the pelvic inlet, the fore legs are bent backwards. The 
examination is often very difficult, the fore legs frequently 
being beyond reach. . . 

For the sake of a correct diagnosis and treatment, it is of 
great importance to know whether one or both carpi have 
entered the pelvic canal. 

The prognosis is favorable with small foetuses, also with 
large ones provided the owner did not attempt to extract the 
calf by the head. When the head has been forcibly drawn 
beyond the vulva, it is advisable to give a doubtful prognosis. 

Treatment.—lt is possible to extract calves in this presen- 
tation in the seventh or eighth months of pregnancy, provided 
- the cervix uteri is sufficiently dilated. The head is fixed with 
a rope behind the ears by placing the noose between the 
branches of the lower jaw, so as to prevent tightening. Should 
the calf be dead, a blunt hook, with a rope, is inserted into 
each internal canthus of the eye. The calf is brought into a 
costal position, so that the bicostal diameter of the calf lies 
parallel to the greatest diameter—the height—of the pelvic 
inlet. Now one or two men can extract the calf. 

We proceed in the same way with calves of normal size 
and with a wide pelvis, as found in cows four and five years 
old. It does not succeed in primipare, especially when only 
two years of age. 

When called in time to such cows and the foetal waters 
have not yet been discharged, it is possible to repel the calf 
and attempt reposition. Reposition is to be practiced by slow 
and persistent pressure, and not by jerks, while the cow is 
standing, or by raising the hindquarters. Should retropulsion 
be impossible and the calf already dead, embryotomy is called 
for. The head is skinned outside the vulva, the neck is re- 
moved subcutaneously, the muscles severed around the 
shoulder; a rope is fastened about the scapula, the fore leg 
drawn from the skin and removed. The other fore leg is now 
adjusted and the calf extracted. When extraction is still im- 
possible, embryotomy is to be continued. 


240 BOVINE OBSTETRICS 


(c) ABNORMAL POSITIONS OF THE HEAD. 


Malpositions of the head are frequently seen in obstetrical 
practice. 

Causes.—One of the main causes is found in the persist- 
ence of the intrauterine position on account of insufficient 
uterine contractions. Incomplete dilatation of the cervix uteri 
may cause the head to turn over in spite of sufficient rotation 
of the calf, when the anterior limbs have already entered into 
the vagina. Again, it is frequently produced when the owner 
pulls on the fore legs while the calf is still in the costal pre- 
sentation. There are people who immediately roll up the 
sleeves after the water-bag has ruptured, pass the hand into 
the vagina and fix the fore legs. Complete rotation has not yet 
taken place at that time. The calf is still partially in the 
costal presentation, in consequence of which the head easily 
turns over when traction is exerted upon the fore legs. 


The head resting against the shoulder. 


Diagnosis.—Both fore legs rest in the pelvic canal, but one 
has progressed a little further than the other one. On explo- 
ration, the side of the neck is felt by gliding over the anterior 
face of the legs, palpating laterally, the ears, and further on 
the eyes and nose are detected. 

This abnormal position is often seen in cows with a pen- 
dulous abdomen. 

Treatment.—Reposition is easy when the calf lives; first, 
because the uterus has not firmly contracted; and secondly, 
because living calves change the position of the body by their 
movements, thus assisting an adjustment. After both fore 
legs have been fixed by cording them above the fetlocks, the 
lower jaw is grasped with the hand by placing the thumb into 
the mouth and the index finger below the jaw. By pulling 
toward the operator the head is brought upon the fore legs, 
and traction is exerted on them. After the head is once in the 
pelvic canal, it is held there by the hand to keep the mouth 
upou the metacarpal bones. 


CLASSIFICATION OF ABNORMAL PRESENTATIONS 241 


Should it be impossible to bring the head into the pelvic 
canal with the hand, a loop is placed around the lower jaw and 
traction practiced. At the same time the obstetrician repels 
the calf by placing the hand against the sternum. With regard 
to the fixing of the rope, attention should be paid that the hand 
which cords the head stays on its side and does not glide across 
the neck to the inferior maxilla. In the latter case the neck 
would be twisted by pulling and reposition becomes impossible. 
When the head rests against the right shoulder, the cow is 
placed upon the right side, and upon the left side should the 
head be turned against that side; this renders reposition 
easiest. 

When the calf is dead the head may be fixed by placing 
the thumb and index finger into the orbital cavities, or a hook 
may be used instead. It is advisable to use the hook only in 
case of necessity. Only when reposition by hand fails, and 
the eye, but not the mouth can be reached, is the application 
of the hook indicated. 

Tn all cases where the foetal waters are completely dis- 
charged and the uterus firmly contracted and the head cannot 
be brought into the parturient passage, embryotomy is called 
for. Both fore legs are removed subcutaneously ; this gives 
ample room to draw the head into the pelvic canal and fix it. 


The head resting against the thoraz. 


This abnormal presentation may follow the preceding one 
when traction is exerted on the fore legs while the head is 
turned against the shoulder (fig. 40). 

Diagnosis.—The internal examination, as in the preceding 
portion, reveals the side of the neck in front of the pelvic in- 
let, while the skin of the neck is more tense. The fore legs 
are further advanced into the vagina. 

Treatment.— The method is the same as in the presentation 
just discussed, but special attention must be paid that traction, 
after cording the lower jaw, is practiced in the right direction, 
to prevent twisting of the neck. On the whole, reposition is 
here no more difficult than in the preceding position. 


249, BOVINE OBSTETRICS - 


In calves which are very large and dead, and where we 
know in advance that total extraction is out of the question, 
especially in a juvenile pelvis, it is better to remove one or both 
fore legs subcutaneously than to draw the head forcibly into 
the pelvic canal. 


The head descended between the fore legs. 


The depression may be limited, so that the ears lie op- 
posite the anterior border of the pubis, but the upper border 
of the neck may be directed against the symphysis. 

Diagnosis.—The fore legs in this malposition have not 
passed as far into the pelvic cana] as in other faulty head posi- 





Fig. 40,—Lateral Deviation of Head, resting on thoracic wall. 


tions. On exploration, the vertex of the head or upper border 
of the neck is felt between the fore limbs, and a little upward 
the withers. By gliding downward on the anterior pubic 
border the dorsal portion of the nose can be reached (fig. 41). 

Severe traction on the legs greatly interferes with palpa- 
tion. In such a case it is advisable to repel the calf and ex- 
amine anew. By placing the cow in a dorsal position the head 
can be readily reached. 

The prognosis is favorable when the calf is alive and the 
foetal waters are not yet entirely evacuated; but is doubtful 


CLASSIFICATION OF ABNORMAL PRESENTATIONS 243 


when the uterus has’ firmly contracted, as it may lead to 
rupture. 

Treatment.—Wherever reposition by hand is possible, it 
should first be done. The cow’s hindquarters are raised or she 
is made to get up; in consequence of this the calf descends, 
The hand is pushed between the fore legs and downward into 
the mouth of the calf, the thumb is placed on top of the nose 
and three fingers into the mouth. By drawing the arm to- 
ward the operator, one often succeeds in raising the head and 
placing it upon the fore legs; this manipulation is greatly 





Fig. 41.—Downward Deviation of Head, between fore legs. 


assisted when an assistant repels the calf by the fore legs. 
Should this method fail, a noose is placed around the lower 
jaw, pulling on it with one hand, while the other repels the 
ealf. The hand which effects this may seize the inferior 
maxilla as soon as it is raised some, and draw it into the par- 
turient passage. 

When all these attempts are without success, the cow is 
put on her back, at the same time raising the hindquarters. 
Now the head is more accessible. After repelling the calf, the 


244 BOVINE OBSTETRICS 


head may be brought upon the fore legs either with the hand 
or by cording the lower jaw. Should a small, blunt hook, to 
which a rope is attached, be inserted into the orbital cavity, it 
should be covered by the hand to prevent injury should it give 
way. Only one man must pull on the hook. 

When all the foetal waters are discharged, an infusion of a 
large amount of warm water must first be administered, before 
reposition is attempted, this procedure rendering it much 
easier (Franck-Goring). 

Should reposition be impossible, one or two fore legs are 
removed subcutaneously, thus gaining sufficient room to reach 
the head. The obstetrician should know the exact state of 
affairs, especially in this abnormal presentation, and take care 
that traction is not exerted on the head with a rope passed on 
the outside of the legs. One usually rejoices when the lower 
jaw is corded, and forgets that the head must be drawn up be- 
tween the fore limbs. After pulling repeatedly and without 
success, the idea suddenly strikes us to pull in the right direc- 
tion—that is, between the fore legs—and to repel the calf at 
the same time. 


The head turned backward and upward. 


This malposition is not often met with in the calf. The 
slow rotation and the short neck prevent it to a certain extent. 

Diagnosis.—The fore legs lie in the vagina, the tracheal 
portion of the neck opposite the pelvic inlet, the lower jaw 
against the rectum. The best guides are the larynx and trache 
of the foetus. The short neck always renders the head ac- 
cessible. 

Prognosis.—When the examination reveals that the supe- 
rior vaginal wall is not injured by previous manipulations, 
prognosis is favorable. 

Treatment.—Reposition by hand is possible in many in- 
stances. For this purpose the lower jaw is grasped by the 
fingers and an assistant repels the calf by the fore legs. Now, 
by drawing the hand toward the vulva, the head enters the 
pelvic canal; a loop may also be placed around the inferior 


CLASSIFICATION OF ABNORMAL PRESENTATIONS 945 


maxilla. The calf is then repelled by resting the hand against 
the sternum while moderate traction is exerted upon the rope, 
thus bringing the head into the parturient passage. 

These manipulations are usually successful, so that a hook 
may be dispensed with. But when the owner or some other 
empiric has severed the body of the lower jaw, or when the 
head is turned to one side, that only the eye but not the mouth 
is accessible, a hook will have to be inserted into the orbital 
cavity. 

It is often stated that, especially in malpositions of the 
head, greater force can be exerted with a hook than with a loop 
around the inferior maxilla. While this statement is correct 
in itself, we must remember that strong traction is neither 
necessary nor desirable. Many a one has drawn a head into 
the pelvic canal by means of two men, which could have been 
brought there without one-fourth the expenditure of force, pro- 
vided sufficient room for reposition had been present; this 
favorable condition could haye been obtained by repelling the 
ealf and replacing the foetal waters by warm water to overcome 
the aspiration force of the uterus. 


(d) ABNORMAL POSITIONS OF THE HEAD AND FORE LEGS. 


The varieties of these complicated positions of the ante- 
rior extremity of the body are numerous. The general rule is: 
anything within reach of the hand is corded; the fore legs at 
the coronet or above the fetlock, the head around the lower 
jaw. It is mostly easier to fix first the head by placing a loop 
around the inferior maxilla, and next to adjust the legs. As 
soon as the latter are corded the head is guided along the fore 
legs into the pelvic canal. 


(e) THE POSTERIOR EXTREMITY OF THE BODY IN THE PARTURIENT 
PASSAGE AND ABNORMAL POSITION OF ONE HIND LEG. 


When the calf presents itself in the abdominal position, 
with both hind legs in the pelvic canal, parturition may take 
place without assistance, as it is a normal presentation. 


246 ‘BOVINE OBSTETRICS 


In fact, this presentation is a favorable one for large calves, 
since by pulling on one leg the trochanters pass obliquely 
through the pelvic canal, after which the other foetal dimen- 
sions rarely form an obstacle ; but in the anterior presentation 
the trochanters occasionally cannot pass the pelvic inlet after 
one-half of the calf is born. 

When one or both hind legs are turned against the belly, 
expulsion is in most cases impossible. It is only possible 
when the calves are small or the pelvis wide. 

Causes.—Insufficient dilatation of the cervix uteri, incom- 
plete rotation, respectively accommodation, at the pelvic inlet 
in consequence of feeble pains, as seen in twin-pregnancy and 
an excess of foetal waters. Violent pains, with too early dis- 
charge of the foetal waters, may also produce this malposition. 


One hind leg retained, the fetlock lying below or against the 


symphysis. 


Diagnosis —The hind leg lies in the parturient passage, the 
exterior surface of the leg is turned toward the floor of the 
pelvis, the plantar surface of the claw is directed upward. 

The hand introduced into the vagina feels the fetlock 
turned upward, and the tendo Achilles, further on the tail, 
the postero-external angle of the ischium, below the gluteal 
muscles, and the fetlock of the retained leg in front of the an- 
terior border of the pubis. 

When the owner exerts strong traction upon the hind leg 
normally presented, its hock is found in the vulva and the 
pelvis of the calf in the pelvic inlet. 

Tn this abnormal presentation the greater part of the foetal 
waters are usually evacuated. 

Prognosis is favorable. 

Treatment.—Small calves, as seen in twin-pregnancy or 
abortion, are occasionally extracted by the owner on the pre- 
senting hind leg in spite of the malposition, In such a case 
the retained leg is firmly pressed against the belly and the 
femur and tibia are extended on the long axis of the body. 


CLASSIFICATION OF ABNORMAL PRESENTATIONS 247 


Should the obstetrician attempt extraction under such cir- 
cumstances, it is necessary that the calf is small and the pelvis 
wide, and that the retained leg is pushed forward as much as 
possible. 

Nevertheless, it is much better to practice reposition, es- 
pecially when the calf is small, as adjustments are more readily 
made in them than in large foetuses. After locating the parts, 
the fetlock of the retained leg is grasped with the hand and 
drawn, if possible, as far as the pubis. Now the whole hand 
is placed against the posterior surface of the tarsus, pushing 





Fig. 42.—One Hind Leg Retained. 


the leg upwards and repelling the calf at the same time. The 
hand now glides down along the shin, holding it firmly, flexes 
the fetlock, and draws it into the pelvic canal, holding the fet- 
lock, coronet and claws in the hand (fig. 42). The greatest 
difficulty consists in the fact that the calf's buttocks enter the 
pelvic inlet with each pain, thus interfering with the retraction 
of the leg. In order to overcome this and to render reposition 
possible, the following treatment has been recommended : 

1. Reposition should be performed in the standing cow 
with her hindquarters raised. 

2. The calf is repelled with the obstetrical crutch. 


248 BOVINE OBSTETRICS 


3. An assistant repels the calf while the operator adjusts 
the retained leg. 

Anybody correcting this malposition for the first time must 
pay special attention to point 2. When the calf is to be pushed 
back by an assistant, he should place the hand against the 
ischium, so that the thumb and index finger are on either side 
and below the tail. The assistant uses the right, the obstetri- 
cian the left arm, or vice versa. The assistant, when able to 
reach the fetlock of the retained leg, should press it upward 
and forward. The obstetrician seizes the strongly flexed fet- 
lock, and, by drawing the hand toward the vulva, guides the 
leg into the pelvic canal. When reposition by hand proves 
impossible, the fetlock of the retained leg may be looped. Now 
the calf is repelled by pressing with the hand the fetlock up- 
ward and forward ; traction is at the same time practiced on 
the cord and the leg enters the pelvic canal. 

Should all the methods previously mentioned fail, the cow 
is placed into a dorsal position, also raising the hindquarters. 
The retained leg is then mostly accessible and, if necessary, the 
fetlock is corded. Severe traction must not be employed here, in 
order to draw the leg into the pelvic canal. The hand not en- 
gaged in the vagina does the pulling, and an assistant is not to 
be trusted. 

Should the uterus here descend to the extent that the 
retained hind leg cannot be reached when the cow stands or 
lies on the side, the dorsal position is to be employed. 


One hind leg in the parturient passage, the other flexed at the hock 
in the pelvic canal. 
(Unilateral hock presentation, Harms.) 


Diagnosis. —Onue-half of the metatarsal bone of one hind leg 
projects beyond the vulva. On exploration, the flexed tarsus 
of the other hind leg is felt, its tibia lying toward the pelvic 
outlet and the shin-bone firmly against the floor of the pelvis. 

This position is usually produced when the owner pulls on 
the hind leg normally presented, while the hock of the retained 
leg was resting upon the anterior border of the pubis. 


CLASSIFICATION OF ABNORMAL PRESENTATIONS 249 


Treatment.—The calf must be cautiously repelled, the 
hand raising the tarsus of the retained leg as much as possible. 
In this way rupture of the vaginal floor is presented. Should 
retropulsion succeed and the hock be removed from the pubis, 
the last named presentation is produced. 

When retropulsion is impossible and the calf dead, the 
hock of the retained leg is severed with the chain-saw. The 
shin-bone and parts below it are removed by hand, and the 
lower extremity of the tibia corded. While extracting by 
means of the hind leg normally presented and tibia, the stump 
of the latter is to be covered with the hand. 

In place of a chain-saw an iron wire may be used to cut 
through the joint. 

In small calves the hock may be drawn into the vulva, 
exarticulating it there with the knife, placing a thin cord 
around the lower extremity of the tibia. 

One may also try to cut the tendo Achilles. In conse- 
quence of it, the shin-bone can be placed against the tibia, and 
more room is obtained. 


One hind leg in the parturient passage, the other hind leg flexed 
completely against the abdomen. 


Diagnosis.—The normal hind leg extends far into the pel- 
vie canal. Slight pulling draws its hock into the vulva. On 
internal examination one feels the tail, postero-external angles 
of the ischium and the buttock of the retained leg opposite the 
pelvic inlet. The tarsus lies way below the pubis. 

Treatment.—Small calves can be extracted in this abnor- 
mal position. The hind leg lying in the pelvic canal is pulled 
at, pushing the ischium of the calf to one side at the same time. 
In this way the greatest diameter of the hindquarters is rend- 
ered parallel to the height or greatest diameter of the pelvic 
inlet. 

In most cases, reposition of the retained leg becomes 
necessary. For this purpose it is placed into the first presen- 
tation, by pulling the hock upon the pubis. This manipulation 
may be executed by seizing the tibia with the hand and draw- 


250 BOVINE OBSTETRICS 


ing it toward the operator. When the tibia is beyond reach 
the cow is placed into the dorsal position, the retained leg now 
being on top and more accessible. When the fetlock is directed 
toward the pubis and the metatarsal bone within reach, the 
latter is grasped by the hand, placing the thumb upon the 
flexed tendons. The thumb now presses the leg upward and 
forward, in consequence of which the calf descends some, the 
hand glides down to the claws and draws the leg into the geni- 
tal canal. This reposition is easiest with the cow in the stand- 
ing posture. When an assistant can repel the calf with the 
arm, more room is gained for work. 

As long as the calf lives everything must be done to effect 
reposition. 

After the calf is dead and all the foetal waters have been 
discharged, and consequently the uterus contracted firmly, a 
great deal of warm water may be introduced into the uterus, 
and another attempt made to adjust the leg. Should every- 
thing fail, one hind leg may be removed at the hip-joint and 
parturition finished by pulling on the leg normally presented. 


(f) ABNORMAL POSITION OF BOTH HIND LEGS. 


Both hind legs may be abnormally presented. Both hocks 
may be below or opposite the pubis, both in the pelvic canal 
with claws turned toward the uterus, or both hind legs lie 
close against the abdomen. 

The first named presentations are treated as already sug- 
gested, only the latter, both hind legs completely retained and 
turned against the belly, require a detailed discussion. 

This malposition is frequent, often causing dystokia, as the 
foetal waters are usually evacuated when we are called. The 
uterus is then moulded upon the calf and interferes with our 
attempts at reposition. 

Diagnosis.—The history is that parturition has been going 
on for some time, and that it is usually uncertain whether the 
water-bag has ruptured or not. The continuous but not strong 
pains have not advanced any part of the foetus as far as the 
vulva, excepting possibly the tassel on the tail. Internal ex- 


CLASSIFICATION Ge ABNORMAL PRESENTATIONS O51 


amination reveals the tail in the vagina, the posterior extremity 
of the calf in front of the pelvic inlet, recognized by the but- 
tocks, the root of the tailand anus. Further ahead the sacrum 
is felt, laterally the trochanters and the posterior gluteal mus- 
cles just in front of the pubis. Advancing further yet the hock 
can be reached by following the tendo Achilles and sometimes 
the metatarsal bones (fig. 43). 

The parts are best located while the cow is standing. 

Prognosis.—When the calf is still alive and the foetal waters 
not yet completely discharged, so that the uterus is not too 
firmly contracted, the prognosis is favorable. But when the 
foetal waters are evacuated, the calf dry, the uterus moulded 





Fig. 43.—Both Hind Legs Retained Under the Body. 


upon the calf, the prognosis must be doubtful, as the uterus 
may rupture without it being the fault of the obstetrician. 

Treatment.—It occasionally happens, that in this presenta- 
tion very small calves or twins may be extracted by pulling on 
the tail. Nevertheless, it is impossible in most instances. In 
case strong traction is applied, itis best to use the so-called 
Saake’s loop. 

An ordinary rope with a loop is carried in front of the re- 
tained legs, and patella, from one side to the other. The hand 
now seizes the loop and draws it outside the vulva; at the same 
time the other end must not be tarned loose. The pointed end 


252 BOVINE OBSTETRICS 


of the rope is nowrun through the loop and the loop thus 
made is pushed by the thumb end forefinger over the loins of 
the calf and is drawn tightly. This loop, lying around the 
flanks and belly, will stand strong traction. 

Harms recommends blunt hooks, 17 em. Jong and 15 em. 
wide, having an ear on the lower end. They are placed in 
front of the patella. A rope is run through both ears, when 
the calf is ready for extraction in this malposition. 

Large calves vennot be extracted in this manner. Insmall 
calves reposition is possible, requiring the same efforts as the 
application of the loop. It is better to effect reposition of the 
retained legs in the manner already mentioned. The leg which 
has been guided into the pelvic canal must always be fixed 
before the other one is adjusted. When the uterus is firmly 
contracted upon a dead calf, no time should be lost with at- 
tempts at reposition, but partial embryotomy is indicated. 
This confines itself to the removal of the hind legs from the 
hip-joints. 

As soon as the hind legs are drawn out the calf may be 
extracted by the flaps of skin or by blunt hooks placed into the 
oval foramen or in front of the pubis. 


2.—CosTaL PRESENTATIONS. 


These belong to the abnormal positions, where the thoracic 
wall lies opposite to the back of the mother. The costal por- 
tion may be present both in the anterior and posterior presen- 
tation. 

Causes.—In the beginning of the pains, when the cervix 
uteri is not yet-completely dilated, the costal position of the 
calf is normal, being the intrauterine presentation. There- 
fore, in those cases where rotation is incomplete, the calf may 
enter the parturient passage on its side, especially when the 
uterus is distended and the pains feeble. 

Diagnosis.—In the anterior presentation the skull is turned 
toward the lateral wall of the vagina, the fore legs and the 
plantar surfaces are directed laterally. 


CLASSIFICATION OF ABNORMAL PRESENTATIONS 253 


Treatment.—When the anterior extremity of the body has 
not yet passed into the pelvis, the head is drawn upon the fore 
legs into the parturient passage; the balance of the calf then 
places itself into the abdominal position. 

When head and fore limbs are already in the vagina, 
traction is exerted on the uppermost leg of the calf while the 
cow is down. For instance, the calf rests on the right side, 
as also the cow ; in this case one pulls on the left fore limb of 
the calf. By doing so a quarter rotation and extraction is now 
possible in the abdominal presentation. When the posterior 
extremity of the body lies on the side, traction is exerted until 
the trochanteric diameter passes the height of the pelvic inlet. 
This is often followed by spontaneous rotation, as the sterno- 
dorsal diameter of the thorax accommodates itself to the 
greatest diameter of the pelvic inlet—that is, its height. Be- 
sides this, numerous other abnormal positions of the head, fore 
legs or hind legs are seen; they are converted into the preced- 
ing presentation. 


3.—DorsaL PRESENTATIONS. 


We speak of a dorsal position when the back of the calf is 
turned toward the abdomen of the parent. It is not frequently 
seen in the cow, but occasionally causes dystokia. The dorsal 
presentation may be complicated by malpositions of the head, 
fore legs and hind limbs. 

Diagnosis.—In the dorsal presentation, with the head and 
fore limbs lying in the parturient passage, the anterior extremi- 
ties rest with their flexion surface toward the inferior wall of 
the vagina. The plantar surface of the claws is turned up- 
ward, making the impression at first as if the hind legs are in 
the pelvic canal. 

Should the hind legs occupy the parturient passage, their 
anterior face is turned toward the roof of the vagina and the 
plantar surface of the claws downward. The owner usually 
imagines that the fore limbs are in the pelvic canal and that 
the head is turned backward. 


954 BOVINE OBSTETRICS 


The diagnosis is not difficult. In the first instance we 
define the position by the head lying under the fore legs, in the 
latter by the hocks and tendo Achilles. 

Treatment.—As long as no part of the calf has entered the 
pelvic canal, treatment is simple. The head is placed upon the 
fore legs by placing the hand against the head and turning it. 
The fore legs are fixed and a loop placed around the lower 
jaw. After the head is once placed upon the fore limbs the 
calf turns by itself. When the hind legs have passed into the 
pelvic canal in the dorsal position, they are pushed back, and 
rotation around the long axis is attempted, by introducing the 
hand between the hind legs of the calf as far as the symphysis. 





Fig. 44.—Dorsal Position, with the Head Turned Back, 


One hand now fixes the hind legs, the other twists the hind- 
quarters ; also, by placing one leg across the other one and 
pulling on it, rotation of the calf can be effected. 


Dorsal presentation with two fore legs in the pelvic canal, the head 


turned backward. 


Diagnosis.—Both fore legs lie with the claws in the vagina, 
the flexion surface turned upwards. On internal examination, 
one feels the sternum, anterior surface of the neck and usually 
the head, by gliding along the exterior surface of the fore legs. 


CLASSIFICATION OF ABNORMAL PRESENTATIONS 255 


The partial contraction of the uterus prevents the head from 
descending further. 

Treatment.—The fore legs are fixed with loops above the 
fetlocks, in order to have them accessible at any time. A loop 
is placed around the lower jaw (fig. 44). 

The cow is put into a dorsal position and then the head of 
the calf is placed on the fore legs, repelling the calf if neces- 
sary. All three cords are tightened and the cow rolled on the 
side. In many cases rotation has now progressed sufficiently 
so that the dorsal position is converted into a costal one. 

Rotation may be assisted by pressure with the open hand 
against the scapula. When the calf is dead and the uterus 
firmly contracted, warm water may be introduced into the 
uterus and reposition tried*once more, or embryotomy is per- 
formed. 

Usually the subcutaneous removal of one or both fore legs 
is sufficient. The head may then be drawn into the pelvic 
canal and parturition finished according to rules previously 
laid down. 


Dorsal presentation with retained fore or hind legs. 


The treatment endeavors to establish a dorsal position, 
where head and fore legs or hind legs get into the parturient 
passage. This reposition is easy by placing the cow on the 
back. After that the case is treated as an ordinary dorsal pre- 
sentation. 


II.—TRANSVERSE PRESENTATIONS. 


In this abnormal position the long axis of the calf forms 
an angle of 90 deg. with the long axis of the mother. 

The dorsal as well as the abdominal region may be turned 
toward the pelvic inlet. Therefore, we recognize transverse 
dorsal and transverse abdominal presentation. 


TRANSVERSE DORSAL PRESENTATION, 


It is more frequently met with in cows which have calved 
repeatedly than in primipare. The. withers as well as the 


256 BOVINE OBSTETRICS 


lumbar region may be turned toward the pelvic inlet. The 
calf does not always lie horizontally; the hindquarters usu- 
ally lie deeper. 

Diagnosis.—On examination, one feels an extensive smooth 
surface, occasionally the hairy skin, when many manipulations 
have been performed and the foetal envelopes torn. 

In this abnormal presentation it is not always easy to make 
a correct diagnosis, especially when the calf is hard to reach. 
In such a case it is advisable to raise the cow’s abdomen by 
means of a board, or to put her on the back. To make 
the diagnosis, the ribs, ligamentum, nuche and external 
angles of the ilium are located; sometimes the tail or ears 
are accessible. 

Treatment.—This depends on the part within reach. Should 
one be able to seize the tail, the hind legs must be brought 
into the pelvic canal. Since the calf is almost always dead, a 
small hook with a rope is passed through the anus into the 
oval foramen when the hindquarters cannot be moved by the 
hand. While one hand pulls on the rope the other rests upon 
the hook. 

As soon as a longitudinal position with the hind legs ab- 
normally presented has been produced, the rules applicable to 
it are employed. 

Whenever possible the hindquarters with the hind legs 
are drawn into the parturient passage, preventing a malposi- 
tion of the head. 

When the anterior extremities are more accessible, 
either the head or one of the fore legs, delivery in an ante- 
rior presentation is attempted by adjusting the head or 
fore legs. 

Whatever the hand can reach must be corded to be ac- 
cessible when needed. The aim of reposition is to convert this 
presentation into a longitudinal one, be it abdominal, dorsal or 
costal, with the anterior or posterior extremities in the partu- 
rient passage. After that a normal presentation is effected 
according to the rules already given. 


CLASSIFICATION OF ABNORMAL PRESENTATIONS 257 


TRANSVERSE ABDOMINAL PRESENTATION. 


In this abnormal position the abdomen of the calf is turned 
toward the pelvic inlet of the cow. This presentation may be 
varied. 


Transverse abdominal presentation with fore and hind legs in the 
pelvic canal. 


This abnormal presentation is rare in the cow. The fore 
legs usually have advanced further into the pelvic canal than 
the hind limbs. On examination, one feels three or four legs, 
so that doubt may arise whether twins are present or not. A 





Fig. 45,—Transverse Position. 


very thorough examination is to be made, extending to the 
position of all the parts of the foetus. 

Treatment.—The hind legs are fixed by looping the fet- 
locks. The cow is either raised behind or made to stand up. 
Now the fore legs are repelled as much as possible and the 
carpi flexed as soon as they pass the anterior border of the 
pubis. 

By placing the left hand against the shoulder with the 
thumb behind the elbow and the four fingers upon the scapula, 
the anterior portion of the body is pushed back, and by pull- 
ing at the same time on the hind legs the transverse presenta- 
tion is changed into a longitudinal one with the hind legs in 
the pelvic canal (fig. 46). 


9258 BOVINE OBSTETRICS 


The right hand guides the assistant in which direction he 
must pull. When the anterior extremities of the body cannot 
be repelled, one or both fore legs are removed subcutaneously. 


Transverse abdominal presentation, the legs not in the pelvic canal. 


Tn this position one usually deals with small calves. The 
cervix is almost invariably incompletely dilated. The fore 
legs are flexed at the carpi, the hind legs extended under the 
body. The treatment attempts to bring the hind legs into the 
pelvic canal. But there are transverse abdominal positions 
where two or three legs lie in the pelvic canal. These are 
recognized and treated according to the rules previously given. 
It happens that the fore legs lhe in the vagina and the head in 
the pelvic inlet while the claws of the hind legs rest upon the 
symphysis. This abnormal presentation, designated by Harms 
“dog-sitting position,” is rarely observed in the cow. 

When the owner pulls on the fore legs until the head ap- 
pears between the labize and the shin-bones of the fore legs 
project at the vulva, repulsion becomes impossible or very 
difficult. 

In the first case the foetus is divided and rotated by means 
of the hind legs. 

In the earlier stages of parturition, when repulsion of the 
calf is possible, the hind legs are pushed away from the pubis 
and the anterior extremity of the body is brought into the 
pelvic canal. 

It is always advisable to make an exact diagnosis of this 
abnormal presentation and to search for the claws or hind legs 
along the floor of the vagina, as this presentation may be con- 
founded with retarded birth depending on ascites. 


Alnormal presentations of twins. 


In malposition of twins, parts of one calf may enter into 
the parturient passage together with parts of the other calf, 
thus interfering with parturition. 

This may give rise to various conditions. Thus the head 
of one calf with the fore limbs of the other calf, or one of its 


CLASSIFICATION OF ABNORMAL PRESENTATIONS 229 


own fore legs or that of the other calf, may enter at the same 
time. In the same manner three or more legs with or without 
a head may appear together in the pelvic inlet. 

Diagnosis.—The diagnosis is best made by locating the 
carpi, elbows, sternnm; on the hind legs, the hocks, tendo 
Achilles and tail. No definite indications can be given here. 
It is absolutely necessary to make a correct diagnosis with 
regard to extraction. 

Treatment.—Since the calves are mostly small, reposition 
is easy. The fore legs of the calf which is most forward are 
fixed ; the lower jaw is also looped. The parts of the body of 
the second ealf, fore, hind legs or head, are repelled, and the 
first calf extracted. 

When two hind legs of a calf enter the pelvic canal they 
are fixed by loops above the fetlocks, This calf is now ex- 
tracted first, while the other one is repelled. 

The attempts at reposition are not very difficult, since as 
a rule only feeble pains accompany multiparous pregnancy. 
Occasionally it happens that the owner pulls on the fore leg 
of one calf and the fore leg of the other calf, thinking he is 
dealing only with one calf. Then fore legs and head are 
wedged in the vagina. In this case the calf must be repelled 
to make a diagnosis; before doing so head and fore legs are 
corded so they may be readily drawn into the pelvic canal. 


DISMEMBERING OF THE FETUS 
(EMBRYOTOMY). 


History.—According to Thomassen, Columella is supposed 
to have been the first one who mentioned embryotomy, in the 
seventh volume (sheep-breeding) of his work. 

Already in the year 1597 Colerus, in his treatise on breed- 
ing and diseases of the domestic animal, advises to call a shep- 
herd in dystokia of sheep, so the young may be delivered as a 
whole or in pieces. 

Eberhard, physician at Zeist (Holland), in 1793 gives in 
his work a method how to perform embryotomy. He enjoyed 
instructions in 1778 under Kersting at Kassel. Fromage men- 
tions Texier senior in 1806, that he repeatedly removed a fore 
leg of emphysematous calves by forcibly pulling the leg off the 
body. 

Le Franeq van Berkhey first mentions two obstetricians 
who dismembered the calf subcutaneously, viz.: J. Blanken 
and J. Lauwen. They used a spatula and a short finger knife. 

G. Wit reports that the practitioners P. Knip, father and 
son, at Beemster, North Holland, first employed the curved 
spatula to skin the head. Both of these obstetricians were 
famous in Northern Holland on account of their dexterity in 
embryotomy. The father performed 1,400 embryotomies from 
1811 to 1855, the son 500 in 15 years. 

Knip and son became so dexterous in embryotomy by first 
practicing it on dead calves by introducing the arm into the 
hole through which the urine of the stable was discharged. 
‘he calf was lying in the stable, while the obstetrician, after 
subcutaneous removal, withdrew the various parts through 
that opening. 

Skellett in 1811 removed the head and fore legs of a calf 
without injury to the parent. 

260 


EMBRYOTOMY 261 


Jorg, who reported this in 1818, remarks that it is impos- 
sible to handle a knife inside the uterus without injuring it, on 
account of the restlessness and straining of the mother. It, 
therefore, would be best to slaughter the animal early. 

S. Fey in 1823 already recommended to repel the head and 
push it downward toward the udder so that the nose rests 
against the pubis, should the head resting on the fore legs 
enter the parturient passage. The fore legs are removed with 
a curved hook and knife by severing the skin around the 
scapula. For extractions he uses forceps. In the handle of 
the curved knife was a hole through which a rope was drawn. 
Whenever desired by the operator, an assistant could pull on 
it and assist in the operation. Fey further states that he saw 
this knife used in 1812 in Cantons Glarus, St. Gallen, Zug and 
Gasterland in dismembering calves within the cows without 
the least injury to the mother. 

Gunther in 1830 describes in his work incisions as well as 
the subeutaneous method in regard to the removal of a fore 
leg. 

Huvelier in 1830 describes the removal of the fore limb of 
a calf with the head turned to one side. He made a circular 
incision through the skin in the middle of the shin-bone, split 
it on the internal surface of the leg as far as the breast, sepa- 
rated it with a bistoury, or better, with the hand, up to the 
shoulder; made a few rotary movements with the leg, corded 
the fetlock, when the leg could be torn off by an assistant. He 
introduced both hands into the uterus to exert counterpressure 
on the foetus. 

Veret, quoted by Wit, in 1837 placed a rope around the 
hindquarters of the parent above the hocks and had assistants 
hold it. The leg of the young which is to be removed is 
corded and fixed, the skin above the fetlock receives a circular 
incision and is split upward. Now the skin is separated and 
the leg pulled off by drawing on both ropes in an opposite 
direction. 

Since that time important communications about embry- 
otomy have appeared by Rychner, Baumeister, Franck, Harms; 


262 BOVINE OBSTETRICS 


in Belgium, by Delwart, Brogniez, Defays, Deneubourg, and 
Thomassen; in France, by Schaack, Rainard, Zindel, St. Cyr 
and Violet; in England, by Cartwright, Nelson, Fleming; in 
Italy, by Cattaneo, Sacchero (Thomassen), Lanzilotti-Buon- 
santi; in Sweden, by Sjostedt; in Holland, by Van Setten, 
Numan and Wit. The school at Utrecht is under obligations 
to the latter, that since 1851 a course in embryotomy on the 
phantom is given. 

Dejfinition—By embryotomy is understood the dismember- 
ing of young in the uterus. It is performed in those cases 
where extraction of the whole foetus is impossible, either be- 
cause it is too large or because the parturient passage is cou- 
stricted. 

Indications.—Embryotomy may be indicated : 

(a) In the Foetus Absolutely too Large. Here belong the 
double-ender and some monstrosities; of the latter, most are 
double monstrosities. A partial or complete embryotomy may 
be also necessary in hydrocephalus, anasarca and emphysema 
of the footus. The parturient passage has a normal diameter, 
but the foetus is too large, so that it cannot be extracted with- 
out dismembering it. 

(b) In the Foetus Relatively too Large. The young is nor- 
mally developed and has the ordinary dimensions. The pelvic 
canal is too narrow, prohibiting the normal passage of the ealf. 
This indication refers to pelvic constrictions, frequently seen 
in the juvenile pelvis or in consequence of rachitis. Exos- 
toses and callus formation in the pelvic canal also may diminish 
the diameter of the pelvic inlet or passage. 

(c) In abnormal presentations of the calf, where neither repo- 
sition nor extraction in the abnormal position is possible. This 
suggests that here embryotomy is frequently indicated while 
in reality its number is limited. The empiric is quickly in- 
clined to see this indication and immediately performs embry- 
otomy. The rational obstetrician attempts reposition with all 
the means at his disposition, usually succeeding in it. In an 
abnormal presentation, embryotomy is only then indicated 
when all endeavors at a reposition prove futile. 


GENERAL RULES FOR EMBRYOTOMY 263 


1.—General Rules for Embryotomy. 


Embryotomy under certain circumstances is a pretty dan- 
gerous operation for the parent. In itself it is not dangerous, 
but when birth is protracted complications may follow which 
endanger the life of the cow. The measures to be taken in 
each case serve to prevent these complications. 

The cow must lie on the right side. Embryotomy ought not 
to be performed in the standing animal. It is dangerous to 
operate with long instruments when the calf’s position devi- 
ates from the line of extraction. The position upon the right 
side is necessary on account of the diagonal position of the 
rumen. This pressure is transmitted to the diaphragm and 
causes dyspnoea. The weight of the calf also interferes with 
the function of the rumen and may give rise to tympanitis. 

The hindquarters of the cow must be raised ; anyway, they 
should not be lower than the anterior extremity of the body. 
These are elevated by placing two bundles of straw trans- 
versely beneath the hind legs, each bundle being tied with 
three cords. This elevation is of advantage to the operator, 
as the calf is not pushed against the pelvic inlet. 

The operation, whenever possible, should be performed within 
the uterus, and not in the pelvis. Since the various manipula- 
tions demand room, the parts wedged in the pelvis must be 
repelled. When it is possible to draw parts to be removed 
outside the vulva, it should not be omitted. 

The obstetrician must practice to operate with the hand 
as much as possible. After some practice, the skin can be 
separated on many places by hand. 

To perform embryotomy but few instruments are required. 
Anyone used to operate with a limited number of instruments 
often obtains better results than he who employs complicated 
instruments. A great deal depends on the instruments one is 
used to handling. The main thing is a systematic execution, 
according to a rational plan to be developed for each case. 

Traction should be exerted by one assistant. The obstet-: 
rician must not pull. He must spare his energies for the 


264 BOVINE OBSTETRICS 


difficult and fatiguing task. In most cases one person suffices 
to extract the various parts of the calf. The force which he 
exerts amounts to about 100 kg. 

Whatever has once been started must be finished. Anybody 
notimmediately successful when performing embryotomy must 
beware of cutting here and there. A regular course must 
be followed ; for instance, when a fore leg breaks off at the 
elbow joint one must not start to remove the other fore leg, 
leaving the humerus and scapula of the former one. It 
matters not how tedious and painful the task, anything we 
once conclude to remove must be entirely removed and no half 
work permitted. 

Anybody living up to these rules becomes an expert ob- 
stetrician in due time; but anybody changing his system 
constantly never becomes competent. 


2.—The Instruments for Embryotomy. 


As the historical review shows, certain cutting instru- 
ments have been employed early to remove parts of the calf. 
‘Thus Gunther describes a curved finger knife and a sliding 
bistoury. Both are still to-day very useful instruments. 

A knife which I use frequently is seen in figure 46. 
Franck-Goring termed it a modified finger knife of the Vienna 
collection. 





Fig. 46.—Finger Knife, 


Fig. 47 shows Giunther’s sliding bistoury; by sliding the 
knob backward, the knife can be introduced within the handle. 

Karl’s embryotome is a finger knife with a cross-piece. 
The latter has sucha shape that one end rests between the 
thumb and index finger, the other upon the little finger. 

A useful finger knife is shown in fig. 48. 


THE INSTRUMENTS FOR EMBRYOTOMY 265 


Dopheide’s embryotome (fig. 49) is not as useful as the 
preceding ones. It is my opinion that it is of little use in 
practice. 


















































































































































































































































Fig. 47.—Gunther’s Bistoury Cache, 


Spatulas are emploped to separate the skin from under- 
lying parts. They are used a great deal in embryotomy. 





Fig 48.—Finger Knife. 


The small spatula, 27 cm. long, is used to separate the skin 
on the fore legs as far and above the carpus, and on the hind 
legs as far as the hock. This is done before the large spatula 
is employed (fig. 50). 

















Fig. 49.—Dopheide’s Embryotome. 


The large spatula, 72 cm. long, has the same shape as the 
small one, its wide end being also blunt. Its handle shows 
a crutch. The wide end is slightly concave in the middle 
(fig. 51). 





Fig. 50,—Small Spatula. 


A large spatula, a modification of the above, is the so- 
called heart-shaped spatula, its wide end being heart-shaped. 
In order to tear at the same time connective tissue the 


266 BOVINE OBSTETRICS 


heart-shaped portion of the spatula shows a notch laterally. 
This acts like a sharp hook when the instrument is retracted. 

The curved spatula is mainly used to skin the head 
(fig. 53.) 













































































Figs. 51, 52, 53.—Large, Heart-shaped and Curved Spatulas. 


The skin knife, one of the most useful instruments, is 
used in the removal of the fore and hind legs and when the 
skin is to be cut within the vulva. It consists of an iron rod 
with a handle on the lower end. The other end exhibits two 
lips of unequal length; between them is a knife with the 
cutting edge upwards (fig. 54). 





Fig. 54.—Skinning Knife. 


When using it the large lip is placed into the skin wound 
in the direction in which the skin is to be split. The inserted 
end of the instrument is covered with the left hand, and by 
pushing the instrument with the right hand the skin is cut. 
While cutting, an assistant tightens the leg. 

Hooks are often used in embryotomy either to tear or ex- 
tract certain parts of the body. At the same time no hooks 
are used when the same result can be obtained by cording the 
parts. Short and long hooks, blunt or sharp, are employed. 
The short hooks, 12 cm. long, have a ring on the straight 


THE INSTRUMENTS FOR EMBRYOTOMY 267 


end, to which a rope is fastened by means of which an assist- 
ant may pull (figs. 55a and 55d). 


Cc. eS - 


Fig. 55a. Fig. 550. 
Sbort Obstetrical Hooks. 


The long hooks, excepting the long sharp hook, are less 
frequently used in embryotomy. They are 60 em. long, the 
straight end being provided with a crutch for traction (figs. 55c 
and 55d). 

















Fig. 55¢e.—Long, Dull Obstetrical Hook. 


The long sharp hook is a very useful instrument when 
probe-pointed to dissect the foetus. The annexed figure 



































Fig. 55d.—Fabricius’s Obstetrical Hook. 


represents such an instrument (fig. 56a). The concave portion 
of the segment forms the cutting edge. This hook has the 
advantage not to cut the skin when slipping, thus preventing 








Fig. 56a.—Long Sharp Hook. 


injury to the uterus or vagina. Hubenet (Holland) placed a 
guard in front of the cutting edge to protect the parent and 
finger in case it should slip off (fig. 560). 

Kruijt’s embryotome (Holland) is a convenient instrument 
for anybody having some practice. It is 60 cm. long, its seg- 


268 BOVINE OBSTETRICS 


ment being 4 em. wide. It is not probe-pointed, but the 
cutting edge is more concave (fig. 56c). 

The embryotome to sever the vertebral column consists of 
a rod 60 cm. long, having a cross-piece with a cutting edge on 
the end. After separating the skin with a spatula, the crutch is 








Fig. 56b.—Hubenet’s Hook. 


taken into the right hand while the other end is passed with 
the left hand beneath the skin. As soon as the spot to be 
severed is reached, the hand, by pressing upon the blunt part 








Fig. 56¢.—Kruijt’s Hook. 


of the cross-piece, drives the knife into the muscles. Rotary 
movements are made with the right hand on the crutch while 
the left hand presses the knife inte the muscles and between 








Figs. 57 and 58.—Knife to Sever Vertebral Column. 


the vertebrie, destroying the connection between them. The 
cross-piece is placed on the opposite side to uccommodate 
those mainly operating with the left hand. 

KR. Boer Han (Holland) has modified and improved this 
embryotome. The crutch is more oblique and the cutting 
edge has also been changed (fig. 58). 


THE INSTRUMENTS FOR EMBRYOTOMY 969 


The vertebral embryotome is employed to amputate the 
neck, dorsal or lumbar region. According to Boer, it may also 
be used to sever muscular tendinous tissue around the scapula, 
coxo-femoral articulation. 

The first to introduce the saw into obstetrics was the 
Hollandish veterinarian, J. H. Hinze, at Mijdrecht. It con- 
sists of a rod 72 em. long, with a sawing surface (14 cm.) on 
one end (fig. 59). 











Fig. 59.—Saw with Handle, 


It is used to cut through the body of the inferior maxilla, 
temporo-maxillary articulation, the ribs, the sacro-iliac articula- 
tion and the ischio-pubic symphysis. 

The long sharp hook, the vertebral knife, and Hinze’s saw 
are only employed in subcutaneous embryotomy. They are 
only of use when the skin has been previously separated to 
quite some extent by the hand or spatula. The hand, which 
always covers the instruments, lies underneath the skin. 





Fig. 60.—Chain Saw. 


Persson introduced the chain saw into obstetrical practice. 
Sjostedt described it in 1875 in his “Handbok i Forlossings- 
konsten.” On each end is a ring to fasten a rope (fig. 60). 
The chain saw is convenient to remove the head, to cut through 
legs abnormally presented; for instance, a carpus wedged in the 
vagina with the leg turned backward. The chain saw may also 
be employed to cut contractions of the neck and the sacro-iliac 
articulation in subcutaneous embryotomy. 


270 BOVINE OBSTETRICS 


Oehmke constructed a short saw which is very practical 
(fig. 61). 

The chisel (fig. 62) is used in subeutaneous embryotomy 
to separate the branches of the inferior maxilla, the thorax, 
the sacro-iliac articulation, a curved neck and symphysis 
pubis. To use it, the obstetrician’s hand carries it to the part 
to be cut, while an assistant drives it with light blows from a 
wooden mallet through the bones. 





Fig. 61.—Finger Saw. 


Instead of the chisel, the sharp heart-shaped spatula may 
be employed to split the ischio pubic symphysis. It is intro- 
duced by covering it with the hand, and is placed against the 
symphysis. A light blow with the other hand against the free 
portion drives it into the cartilage. By further twisting and 
pushing it, the symphysis is separated. Forceps serve to 





Fig. 62.—Embryotomy Chisel. 


extract portions of the foetus after the skin has been separated; 
for instance, the branches of the jaw, the neck, the thoracic 
wall, the dorsal and lumbar region, the sacrum and one half of 
the pelvis. They may be dispensed with when we accustom 
ourselves to use the sharp probe-pointed hook and the rope. 
Kruijt, André and Van der Linden have constructed useful 
forceps for embryotomy. 


, 


3.—Partial Embryotomy. 


Indications.—Partial embryotomy confines itself to remoy- 
ing certain parts of the calf, to render possible the passage 
of the balance of the body. It is indicated when certain foetal 
diameters exceed the pelvic dimensions. When the bicostal 


PARTIAL EMBRYOTOMY OF 


diameter is excessive, one or both fore legs are amputated, 
thus allowing the thorax to pass the parturient passage. This 
wedging of the calf is frequent. The head and fore legs 
rest in the vagina, and the withers in front of the pelvic inlet. 

When the hind legs lie in the pelvic canal and the distance 
between the calf’s trochanters exceeds the pelvic diameter, the 
removal of one hind leg and possibly one half of the pelvis of 
that side may be indicated. 

Partial embryotomy is indicated in many cases. Those 
cases most frequently encountered in practice shall be dis- 
cussed more closely. 

Before doing so I wish to lay stress upon the fundamental 
rule: Operate subcutaneously whenever possible. Dismem- 
bering of the foetus is preferable to any other method. While 
it may take a little longer than the other method, that is, 
simple incision, where the skin is removed with the part of 
the body, it always has a greater tendency to lead to a more 
successful termination. 

It is often astonishing how little the cow suffers by this 
operation, sometimes occupying three to four hours. It often 
happens that she lies quietly and ruminates while the surgeon 
operates. Embryotomy properly performed causes the animal 
little suffering. After it is finished she gets up, and in most 
cases but little after treatment becomes necessary. 

The obstetrician has a serious task. He must be possessed 
of thorough anatomical and obstetrical knowledge, must act 
with judgment and show great endurance while operating. 
He must never be wanting in patience. 


THE SUBCUTANEOUS REMOVAL OF ONE FORE LEG IN 
THE PELVIC CANAL. 


The fore leg to be removed must lie in the parturient 
passage, the claws and fetlocks in the vulva. On exploration 
with the hand and arm, the whole leg as far as the withers 
must be within reach. 

When head and fore legs lie in the canal, it is impossible 
to remove one fore leg for want of room. The calf must be re- 


272 BOVINE OBSTETRICS 


pelled, and the head turned to one side or depressed between 
the legs. The other fore leg, if possible, is flexed at the knee 
and returned to the uterus. In this manner the leg to be am- 
putated occupies the pelvic canal alone, and only thus can the 
operation be properly performed. 

Modus operandi.—The coronet of the claw is looped and the 
rope, fastened to a round stick, is tightened by an assistant. 
The cord must be long enough so that the assistant does not 
interfere with the obstetrician’s manipulations. 

Now two longitudinal incisions, 8 to 10 em. long, are made 
with the finger knife or bistoury at the fetlock, one at the in- 
side, the other one at the outside of the leg. 

The small spatula is next introduced into the skin wounds, 
the skin is separated over the shin and along the flexor tendons 
a little above the carpus, first on one and then on the other 
side. The spatula is to remain close to the skin and must not 
get between the flexor tendons, as it renders the work difficult. 
The movements of the spatula are followed by gliding the left 
hand over the skin. 

After this the large spatuia is introduced at first into the 
inner skin wound, while pushing the spatula ahead with the 
right hand, and following its movements with the left hand 
which glides along the skin, the integument is separated 
along the radius as far as the sternum, in front beyond the 
shoulder joint and behind as far as the extensor muscles. 
One operates with long steady strokes and no jerky move- 
ments, 

The spatula is worked in the same way when inserted into 
the external skin wound, separating the skin as far as the 
withers over the whole scapula, until the easy movement of 
the spatula indicates that the parts servered from the inside 
have been reached. At this moment only a few connective 
tissue strips unite the skin with the parts below it. 

Now the incision on the inside is prolonged as far as the 
elbow. For this purpose the skin kuife is placed into the 
incision. By pushing the instrument ahead and covering its 
inserted end with the other hand, the skin is quickly split. 


PARTIAL EMBRYOTOMY bit 


The hand is next passed underneath the skin, breaking 
loose all connective tissue fibres so that the ligamentum nuchee 
above and the anconei muscles behind can be grasped. To 
facilitate extraction of the leg, the pectoral muscles and some 
common muscles around the scapula and the 
brachial plexus may be cut with the sliding 
bistoury or finger knife. Of course this is 
not necessary, but the operation is easily 
performed with the sliding bistoury under- 
neath the loose skin. 

Finally a circular incision is made 
through the skin at the fetlock, the loose 
skin is pushed up, the loop of the cord 
placed above the carpus, and the leg ex- 
tracted by the assistant (fig. 63). 

The main point in this operation is the 
thorough separation of the skin; the balance 
is easy. 


REMOVAL OF THE HEAD (DECAPITATION). 


It may be done in two ways, subcutane- 
ously and with an open incision. Decapita- 
tion with the skin is best done with the 
chain saw. 

For this purpose the head is secured 
with a loop around the lower jaw or by 
means of a hook in each internal canthus of 
the eye, to prevent its swinging to and fro 
while sawing. To start the saw well it is 
advisable to make a small incision behind 
the ears. Now the saw, which has a cord 
on each end, is introduced, pressed into the 
incision, and the operation begins. 

It is well to watch the saw, as it may break when turning 
over. This operation is quickly done, requiring ouly a few 
minutes. This method is disagreeable, as it renders difficult 
the subcutaneous removal of the neck, as no skin flaps are pre- 





Fig. 63. 


274 BOVINE OBSTETRICS 


sent by which the parts can be fixed, as in subcutaneous re- 
moval of the head. 


THE SUBCUTANEOUS REMOVAL OF THE HEAD. 


This difficult operation, which in most cases can be 
avoided and which is performed outside the vulva whenever 
possible, is performed as follows: 

The head is fixed with a small hook, inserted into a cut 


on top of the nose. On both sides of the mouth along the ex-. 


ternal surface of the lower jaw the skin is incised and separ- 
ated by the thumb and index finger. Now the spatula is intro- 
duced and the skin separated as far as the temporo-maxillary 
articulation over the masseter muscle. By gliding with the 
spatula over the inferior border of the lower jaw toward its 
internal face the tongue is freed. 

The hand, resting upon the skin, always follows the move- 
ments of the spatula in order to prevent injury of the genitals 
should it slip down. 

When the branches of the inferior maxilla have been 
separated in this way, the skin still adhering to the chin is cut 
with the bistoury. The probe-pointed sharp hook is placed 
under the skin and pushed as high as possible behind the 
posterior border of the lower jaw. After turning the instru- 
ment its edge is applied against the joint, and by pulling slowly 
the branch of the lower jaw is cut off close to the articula- 
tion. The body of the lower jaw is also severed with the hook 
or bistoury. 

Each branch of the jaw is now loose and may be taken 
away with the forceps or loop placed around the jaw behind 
the molars. The tongue still lies on the skin. 

The incision upon the nose is prolonged 5 to 6 em. and 
the skin separated with the finger and thumb as far as_pos- 
sible; the small spatula is used as far as the eyes and curved 
portion of the skull. Now the curved spatula is introduced to 
separate the skin from the cranium and neck as well as behind 
and to the sides of the ears. This is a difficult piece of work, 
as here the skin is closely moulded to the parts. The spatula 


PARTIAL EMBRYOTOMY 275 


sometimes must be twisted right and left to accomplish its 
purpose. 

Now the ears and the skin around the eyes still remain. 
The former are cut off by passing the sharp hook underneath 
the skin and inserting it back of the concha; (care must be 
taken that the skin has been well separated previously). 

After separating the skin between the eyes and ears with 
the curved spatula, the sharp hook is placed underneath the 
skin behind the eyelids, cutting them slowly. Finally the 
union of the buccinator with the alveolar border and lip is 
cut with the bistoury. The head is now only connceted with 
the trunk by the occipitoatloid articulation; otherwise it lies 
loosely in the skin. Exarticulation of the head is performed 
with the vertebral knife. It is carried with the hand along the 
hard palate closely behind the styloid processes, the cutting 
edge is placed laterally over the joint, the fingers pushing the 
knife downward. While twisting the handle with the right 
hand and pushing against the knife with the left one, the joint 
is entered. The knife now turns and severs the parts. 

Finally the ligamentum nuche and cervical muscles are cut 
with a bistoury, when the head can be extracted by means of a 
hook. 

The flaps of the skin are kept apart by two assistants by 
means of two ropes, one on each side, which have been run 
through the openings for the eyes. When necessary, the 
obstetrician may now remove the neck subcutaneously. 


THE SUBCUTANEOUS REMOVAL OF ONE HIND LEG IN THE 
PELVIC CANAL. 


When both hind legs lie in the parturient passage, but 
total extraction impossible, one hind leg is to be removed. It 
is not necessary to repel the other hind leg, as mostly ample 
room is present for.the operation. 

Modus operandi.—The hind leg to be removed is extracted 
as far as possible until the fetlock appears in front of the vulva. 
An assistant fixes it with a loop in the same way as it was 
done in the fore leg. The skin is incised on either side of the 


276 BOVINE OBSTETRICS 


fetlock to an extent of 8 to 10cm. The skin is separated with 
the small spatula from the deeper parts above the nock. 
Here attention must also be paid to avoid getting between the 
flexor tendons and to remain just underneath the skin. Sep- 
aration is a little more difficult along 
the posterior bones and tendo Achilles, 
but succeeds with some patience. 

Now the large spatula is passed 
into the external wound to separate the 
skin a little beyond the patella or over 
the muscles of the croup as far as 
the sacrum, behind up to the posterior 
gluteal muscles. In the same way on 
the inside, in front up to the patella, 
behind a little beyond the semi-tendin- 
osus muscle. While the right hand 
manipulates the instrument the left one 
follows its movements on the skin. 

When the skin is separated all over, 
detected by the easy movements of the 
spatula below the skin, the skin incision 
on the inside is prolonged, splitting the 
skin as far as the patella. This is done 
with the skin knife in the same manner 
as in the fore leg. The largest projec- 
tion is inserted into the skin; the left 
hand covers the knife and follows it, 
while the right hand pushes it forward. 

Next the hand is passed under the 
skin to tear loose any connections not 

Fig. 64. separated by the spatula. Should it be 
difficult here and there, the sharp probe- 

pointed hook is employed for that purpose. After the whole 
leg lies loosely in the skin, the sliding bistoury or finger knife 
is passed under the skin as far as the muscles of the croup, 
cutting them from before to behind as far as the joint. The 
incision through the muscles ought to be made as long and 





PARTIAL EMBRYOTOMY NTT 


deep as possible. Finally, the skin of the fetlock is circum- 
cised, pushed up, and the loop passed beyond the hock. An 
assistant can now extract the leg from the skin with some 
force. In emphysematous calves the muscles need not be 
cut through. The leg may be extracted as soon as it is 
skinned (fig. 64). 


THE SUBCUTANEOUS REMOVAL OF A FORE LEG RETAINED UNDER 
THE ABDOMEN. 


This operation may be indicated when both fore legs are 
pushed under the body, with the head in the vulva, and when 
repulsion of the calf is impossible. 

Modus operandi.—The head is secured with a loop around 
the lower jaw, or with a hook in the eyes, and extracted if 
possible beyond the vulva as far as the ears. The force of one 
man is sufficient for it. The head is skinned outside the 
vulva, exarticulated, removed, fastening a cord in each hole for 
the eye to enable an assistant to keep the flaps of skin apart. 
Next the skin of the neck is separated as far as the first ribs, 
by the hand or small spatula. 

The union between the last cervical and first dorsal verte- 
bre is severed with the vertebral knife. A loop is placed 
around the neck and handed to an assistant, who can extract 
the neck from the skin. 

The hand is now passed underneath the skin to separate 
it at the shoulder and to tear the muscles common to that. 
region. The sharp hook may be employed. As soon as the 
shoulder is detached, the neck of the scapula is corded, pass- 
ing the rope to an assistant for extraction. Finally the fore 
leg is pulled from the skin, severing it at the coronet. 


THE SUBCUTANEOUS REMOVAL OF A HIND LEG RETAINED UNDER 
THE ABDOMEN. 
Reposition should be attemped first when one hind leg 


lies in the pelvic canal and-the other underneath the belly. 
Should it fail, the hind leg normally presented may be removed, 


278 BOVINE OBSTETRICS 


when the retained leg can usually be adjusted and brought into 
the pelvic canal. 

But when both hind legs are retained and it is impossible 
to extend the legs or practice extraction in this malposition, 
removal at the hip joint is indicated. 

Modus operandii—To operate successfully, the hind- 
quarters of the calf must be fixed. For this purpose a rope is 
placed around the tail as far up as possible, an assistant pull- 
ing on it. Now the tail is doubled up and a new loop is 
placed around these parts over the first loop. 

It may also be fixed nicely by passing a short hook with 
a cord into the rectum, into the oval foramen, by means of 
which an assistant draws on the hind parts. 

The obstetrician passes the sliding bistoury along the tail 
as far as the coxo-femoral articulation. Since the assistant 
pulls the pelvis of the calf against the pelvic inlet of the cow, 
the incision of the hip joint can be made on a comparatively 
immovable basis. 

The incision through the skin is made from the hip joint 
as far as the postero-external angle of the ischium and suffi- 
ciently long to permit introduction of the hand. 

The skin is now separated with the hand, or better, with 
the fingers, upward, forward and downward, until the patella 
is within reach. After doing it the muscles of the hind leg are 
cut with the finger knife, not forgetting the biceps femoris and 
semi-tendinous muscles and the attachment at the cotyloid 
cavity. The noose of a rope is now passed under the tro- 
chanter around the thigh and back, running the free end of the 
rope through it. The loop thus formed is placed firmly below 
the trochanter with the fingers and thumb. An assistant now 
pulling on the rope dislocates the head of the femur and the 
leg can be extracted from the skin. The higher up the skin is” 
separated, the easier the extraction of the hind leg. Extrac- 
tion may also be assisted by separating the skin from the 
underlying parts, especially the tendo Achilles, while trac- 
tion is exerted. After the leg has been pulled out of the skin 
a circular incision is made at the fetlock, and the hind leg 


PARTIAL EMBRYOTOMY 279 


can be removed. The skin flaps are fixed, to be employed 
when necessary in extraction. 


THE TURNING OR VERSION OF THE CALF FOLLOWING DIVISION. 


Definition—By version is understood the repulsion and 
rotation of a part of the body primarily presented at the pelvic 
canal and the introduction to the parturient passage of a part 
at first distantly located. 

In most cases version of the whole calf is impussible. It 
may be attempted with very small calves when the uterus is 
not contracted and the greater part of the foetal waters still 
present. When the calf is wedged, projecting as far as the 
withers at the vulva, rendering further extraction impossible, 
the parts already born may be amputated, the skin tied over 
the trunk and the hind parts repelled and turned so that the 
hind legs may be guided into the pelvic canal. 

Indications.—It frequently happens that a calf is extracted 
as fur as the withers or even further beyond the vulva, but 
that further delivery, in spite of traction, is impossible. This 
depends on various causes. In most cases the trochanteric 
diameter of the calf exceeds the height or width of the velvic 
inlet. The external angles of the ilia are mostly in the pelvic 
passage and the trochanters in front of the pelvic inlet. Any- 
body who has handled a number of such cases knows that the 
distance between the external angles of the ilia is not the 
cause of dystokia. An excessive trochanteric diameter is 
mostly seen in double-enders, in which the hind parts are 
sometimes only voluminous. In these cases the anterior por- 
tion of the body has been extracted with a great deal of 
trouble, the foetal sacrum catching on the sacrum of the cow. 

Saake states that the stifle presentation may produce dys- 
tokia. This presentation is only diagnosed when the ealf is born 
as far as the lumbar region. Onexamination, the stifle is found 
in front or below the pubis of the cow, the femur perpen- 
dicular. . 

Version succeeding division may be indicated also in some 
monstrosities. 


280 BOVINE OBSTSTRICS 


Modus operandi.—After the anterior extremities are born 
as far as the withers, the skin of the calf’s thorax is cireumeized 
15 cm. from the vulva. The subcutaneous connective tissue is 
now separated by the hand as far as the vulva, going as far as 
possible in all directions. After this has been accomplished 
the vertebral knife is introduced under the skin, severing the 
spinal column exactly behind the last rib. The abdominal 
muscles are torn with the hand while an assistant extracts the 
anterior extremities and thorax. Now the abdominal viscera 
are removed, the skin secured over the stump, twisting a rope 
tightly around it. It should be long enough so that the stump 
may be returned at any time into the pelvic canal. 

Next the stump (hind parts) is pushed into the uterus by 
the hand. This manipulation is greatly assisted by raising 
the cow behind. After the hind parts have been repelled and 
rotated, first one hind leg and then the other is searched for 
and guided into the pelvic canal. Version of parts lying in 
the uterus is often very difficult, as the pains constantly push 
the repelled mass against the pelvic inlet, thus rendering 
impossible the reposition of the hind legs. 

Some operators (Wit) fasten a moderately thick and 
pointed stick loosely in the skin, placing its point into the ver- 
tebral canal. After the posterior extremities are repelled, an 
assistant holds the stick, gently pushing it, until the obstet- 
rician seizes a hind leg; this is followed by immediate removal 
of the stick. When version is already completed, a hind leg 
may be subcutaneously removed in the manner previously 
described ; when necessary, one half of the pelvis of the same 
side, rendering subsequent extraction easy. This method, 
while frequently employed, has certain disadvantages to be 
remembered. A calf once decomposing has a tendency to 
infect the cow when rotated after removing and tieing the skin. 

This danger may be prevented when the operation is per- 
formed as described under “Complete Embryotomy.” When 
embryotomy has once commenced, it is well to keep out of the 
uterus as much as possible, avoiding explorations without 
previously disinfecting the hands and arms. 


COMPLETE EMBRYOTOMY 281 


4.—Complete Embryotomy. 


Every practitioner has his own method, One gradually 
deviates from the original method, modifying it according to 
one’s views and experience. 


METHOD ACCORDING TO VAN DER LINDEN’S (HOLLAND) 
DESCRIPTION. 


Presentation of the Calf.—The head upon the fore legs in the 
vagina, often tightly wedged by the attendant. The calf is 
absolutely or relatively too large. 

Modus operandi.—The vulva is washed with warm water; 
the fore legs are repelled, flexed at the knees, guided into the 
uterus and placed under the belly of the calf. 

A small hook is inserted into the nose and the head 
drawn iuto the vulva as far as the eyes. Now one hook is 
placed into the eye, an assistant pulling at it. When the legs 
have been repelled well, the head always projects from the 
vulva as far as the ears, and may be skinned and removed. 

The neck can be easily skinned with the hands. To do 
this he uses liquid soap and warm water. As a consequence 
the muscles become limp, so that the connective tissue can be 
readily severed by the hand. When the neck is thoroughly 
skinned and moistened with soap suds, the forceps is intro- 
duced and the neck removed. As soon as the neck is got rid 
of we again go under the skin, separating the shoulder of the 
upper fore leg, which is mainly done by the hand. After 
separating the shoulder a strong cord is passed around the 
neck of the scapula and the fore leg pulled out of the skin. 
The hands are now well washed and lubricated and the other 
leg adjusted. The obstetrician pulls on the skin of the neck, 
au assistant on the fore leg which has been guided into the 
pelvic passage, and in most cases the calf appears as far as the 
withers. 

The fore leg, with the first dorsal vertebra, the anterior 
ribs and viscera, are removed and the skin separated as far as 
the forceps can reach. Now six or seven dorsal vertebre are 


282, BOVINE OBSTETRICS 


severed with the forceps. During this manipulation plenty of 
soap suds are used, permitting the forceps to advance readily 
and allowing us to ascertain whether any skin is between the 
forceps or not; thus the lumbar region is soon reached with 
the forceps. 

Now the skin is separated over the hip joint of the upper 
hind leg, the muscles are cut with the sharp hook, the femur 
exarticulated (torn loose with a rope), a cord passed around 
the femur behind the trochanter, and the leg extracted from 
the skin. Finally, the loop of a rope is passed through the 
oval foramen and tightened so as to rest against the anterior 
border of the opposite ilium. When the pelvis is fixed in this 
manner no fear need exist that the part will break, one person 
being sufficient to extract the remains of the calf. 

The forceps used by Van der Linden is very strong. The 
handles are 52 cm. long, the jaws 15 cm. The handles are 
connected in the middle by a threaded transverse piece so that 
the jaws can be tightly screwed together. 


METHOD ACCORDING TO KRUYT’S (HOLEAND) DESCRIPTION. 


The presentation of the calf is the same as before. 

Modus operandi.When necessary, one or both fore legs 
are repelled to seize the head. After the head has been fixed 
by means of one or two little hooks in the orbital cavities, two 
incisions are made with the ordinary knife, one below the head 
between the branches of the inferior maxilla, one across the 
head between the eyes, both as far as the edge of the lip. 
Both these flaps are skinned to the union of the tongue and 
larynx, with the lower jaw severed. The branches of the 
inferior maxilla are severed, and, by twisting, removed with the 
hand. The skin of the superior maxilla is separated as far as 
possible with the knife and detached from the cranial parietes 
with the curved blunt spatula. The ligamentum nuchie and 
atlo-axoid articulation are cut with a sharp curved spatula. 
Now a small hook with a cord is fastened in the foramen mag- 
num. By pulling on it the head is brought forward and may be 
removed with the knife. The neck is left undisturbed and the 


COMPLETE EMBRYOTOMY 283 


upper fore leg is subcutaneously removed as already described. 
When traction is now exerted on the other fore leg one half of 
the calf will project at the vulva, followed by amputation of 
the neck, fore leg and breast. Further manipulations with 
the knife become possible when now two persons pull on the 
skin of the calf. Next, the last ribs, belly, dorsal and lumbar 
region and thigh are skinned by hand. Kruyt uses for this 
purpose linseed meal paste in large quantities, reducing the 
labor of separating the skin by hand to a minimum. The ribs 
are cut with the sharp hook along the vertebral stalk and 
extracted with the forceps. 

After removal of the viscera, only the hind parts and the 
whole spinal column remain. When the back has been well 
skinned, the forceps can be passed as far as the pelvis, and the 
whole vertebral column cut off at once. 

The muscles along the lambar region and the broad pelvic 
ligament of the upper side are cut with the small sharp hook, 
and the internal angle of the ilium and the underlying wing of 
the sacrum is taken off with Hinze’s obstetrical saw. After 
the saw has passed through the bones, the large hook is 
passed through the same cut to sever any soft tissues still 
adhering. He incises the muscles around the cotyloid cavity 
with a small hook, pushing the instrument between the femur 
and pelvis to cut the soft parts as deeply as possible. 

Into this incision is passed the large hook, pulling from 
within outwards, displacing the head of the femur and rup- 
turing the round ligaments at the same time. 

In order to split the ischio-pubic symphysis he employs 
asharp heart-shaped spatula. To insert the instrument he 
locates the proper spot with the nail of the thumb. With a 
light blow upon the handle the instrument is driven into the 
cartilage ; twisting it to the right and left, the symphysis is 
separated. The disarticulated half of the pelvis is extracted 
with a rope or forceps. 

Traction is next exerted upon a rope placed around the 
femur and the balance of the calf delivered. 

This method only requires one man for traction. The 


284 BOVINE OBSTETRICS 


execution of this complete embryotomy usually takes about 
two and one half hours. 

Kruyt’s small hook is 60 em, long, its segment being 4 cm. 
wide. 

The forceps is 86 cm. long, the long handles are 68 cm. 
long and about 3: 1.5 cm. wide. The short handles are 18 cm. 
long and 2.75: 1.5 em. wide. The slightly curved sharp jaws 
have a length of 8.5 em. and are at aright angle to the thinnest 
side of the shortest handles. 


THE METHOD AT THE VETERINARY SCHOOL AT UTRECHT. 


My esteemed predecessor and teacher, Weitzel, followed 
a method for complete embryotomy on the phantom and in 
practice, which was modified later in practice but nevertheless 
must be looked upon as the most rational operation. This 
method, somewhat modified by me, is as follows: 

Presentation of the calf_—Head and fore legs drawn firmly 
into and usually wedged in the pelvic canal. 

Modus operandi.—The calf is repelled, the head turned 
laterally against the thorax. The leg to be amputated is 
drawn as far as possible beyond the vulva and fixed. This 
fore leg and the other one are removed subcutaneously in the 
manner already described. The head is adjusted, diverted 
into the pelvic canal and pulled out of the vulva by means of a 
loop around the lower jaw or a hook in the internal canthus of 
the eye. 

The head may now be skinned outside the vulva, one 
incision being made along the nose and skull and one between 
the branches of the lower jaw. After exarticulating the head 
at the occipitoatloid articulation it may be removed. 

The assistants secure both skin flaps by passing a rope 
with a loop through each hole for the eye. The skin is separ- 
ated with the hand, if possible, or small spatula around the 
neck as far as the first ribs, the trachea is removed and the 
last cervical and first dorsal vertebree divided with the verte- 
bral knife. An assistant may then extract the neck by placing 
a loop around it (fig. 65). 


COMPLETE EMBRYOTOMY 285 


The skin of the neck, which may now be drawn from the 
vulva, is incised as far as the vulva. 

The skin over the ribs and back is separated with the 
large spatula, the left hand resting upon the skin, always 
following the movements of the spatula. The skinning may 
be readily done with the hand. It is of great importance to 
separate the skin well; unless this is 
done many difficulties are encountered 
later. 

When the hand can pass below the 
skin all over the thorax as far as the Jast 
rib, the costal cartilages at the sternum 
are cut from the last rib to the first one— 
that is, postero-anteriorly—with the sharp 
probe-pointed hook. 

This may also be done with Hinze’s 
saw or the sliding bistoury. 

Next the ribs are severed as close as possible to the verte- 
bral column with the sharp hook. The chisel may be used 
instead. 

The incisions with the hook are made 
from the last rib to the first one. One 
must be careful not to cut the vertebral 
attachments of the ribs first and then the 
sternal, as it is then exceedingly difficult 
to sever the costal cartilages after they are 
detached from the vertebral column. The 
hand may extract the thoracic wall after 
it is removed in this way (fig. 66). 

The other thoracic wall is removed 
in the same manner. By pulling on the 
skin flaps the trochanters of the calf come in front of 
the pelvic inlet and its back into the pelvic canal. The 
skin is incised as far as the vulva. The intestines are 
detached with the hand and removed (exenteratio). The skin 
over the back as far as the sacrum is separated by hand, if 
necessary with the spatula, always stretching the skin flaps 








286 BOVINE OBSTETRICS 


outside the vulva while executing the above. At the same 
time it is necessary that one can reach the posterior border of 
the broad pelvic ligaments and base of the tail and coxo- 
femoral articulation. Any connective tissue fibres which 
might be present are torn with the hand or with the probe- 
pointed sharp hook. Next the long, sharp and probe-pointed 
hook is passed under the skin as far as the base of the tail. 
The probe-pointed portion is pushed downward on the side of 
the tail until its cutting edge is directed against the pelvic 
ligament. Pulling the hook now strongly, the broad pelvic 
ligament and muscles of the croup are severed as far as the 





Fig. 67. 


sacro-iliac articulation. In order to draw the hook through 
the joint, it is given a quarter turn, so that the probe-point is 
directed outwards. A strong pull with the hook splits the 
joint. The rotation of the hook is necessary considering the 
direction of the sacral wings. 

The instrument is inserted in the same manner to cut 
through the broad pelvic ligament, muscles of the croup and 
sacro-iliac articulation. 

An assistant may now extract the back, loins, sacrum and 
tail when a loop is placed well back around the vertebral 
column. The tail is pulled out of the skin (fig. 67). 


COMPLETE EMBRYOTOMY 287 


Often the balance of the calf may now be extracted by 
pulling on the skin. 

Should this fail, one half of the pelvis is to be removed. 
- For this perpose the symphysis must be split. This may be 
done with the sliding bistoury, the finger knife or with the 
sharp hook. 

The latter, with the probe-point down, is placed against 
the ischiatic arch, tearing the union. The symphysis may also 
be severed with the chisel. It is placed upon the anterior 
pubic border, exactly in the middle, an assistant driving it 
with light blows from a wooden mallet. The pelvis may also 
be divided with Hinze’s saw. After separation has been 
effected one way or the other, the obstetrician draws the loop 
of a cord along the lower side through the oval foramen and 
then along the outside of the ilium back; the free end of the 
rope is put through the loop, pushing 
it over that portion of the pelvis 
with the thumb and index finger. 
Now an assistant may extract that 
half of the pelvis (fig. 68). The other 
half of the pelvis may be removed 
similarly. The head of the femur 
ean now be plainly felt. The 
muscles around the upper portion of the thigh are severed 
with the hand and a loop placed below the trochanter. An 
assistant pulling on the rope, vigorously, can bring it into 
the parturient passage. As soon as its superior extremity 
passes into the pelvis the other hind leg enters also and 
parturition is at an end. 





EMBRYOTOMY IN THE POSTERIOR PRESENTATION WITH BOTH HIND 
LEGS IN THE PELVIC CANAL. 


When complete extraction is impossible in this position, 
one hind leg is removed subcutaneously, as previously dis- 
cussed. By pulling now on the other hind leg, extraction of 
the calf is usually successful. 


288 BOVINE OBSTETRICS 


Should this fail, then embryotomy is continued. First 
that half of the pelvis is removed from which the leg was taken 
off. For this purpose the hand or spatula is passed under the 
skin previously split, skinning the sacrum and loins. The sacro- 
iliac articulation is eut with the probe-pointed sharp hook or 
sliding bistoury. Next the symphysis.is severed with the 
chisel or cut with the sharp hook, finger knife or saw. 

When now a cord is passed through the oval foramen, this 
half of the pelvis can be extracted. An assistant drawing on 
the hind leg pulls the loins of the calf outside the vulva, the 
withers being in front of the pelvic inlet. 

The hind leg is skinned, the skin incision is prolonged on 
the inside a little beyond the pubis, so that this incision runs 
into the one of the hind legs previously removed. The skin 
is separated with the hand and the balance of the pelvis and 
loins removed. An assistant fixes both skin flaps outside the 
vulva, so that the hand operates entirely below the skin. 

Now the abdominal and thoracic contents are removed 
with the hand. 

After this has been done, one fore leg is removed at the 
shoulder. This is performed as follows: The skin is sep- 
arated on one side with the hand, or the long spatula, across 
the ribs anteriorly beyond the shoulder, tearing with the hand 
or probe-pointed sharp hook the muscles of the shoulder. 

Nex’ the scapula is curved and the fore leg is extracted 
by one man. Some operators cord the neck of the scapula, or 
even the humerus. In the latter instance it may happen that 
when the scapular muscles are not completely severed, the 
humerus breaks, or that the scapula does not follow in the 
direction of the pelvic canal, but becomes vertical, interfering 
with the extraction of the leg. 

Atter the removal of the fore leg, the skin, still adhering 
to the fetlock, is circumcised. Ihe other fore leg is removed 
in the same way. The ribs are cut with the sharp hook or 
finger knife along the sternum from the first to the last rib, also 
the union of the ribs with the spinal column, finally removing 
the thoracic wall. 





COMPLETE EMBRYOTOMY 289 


The other thoracic wall is detached similarly, followed 
by extraction of the balance of the calf by the flaps of 
skin previously secured. Harms’s method of incising the skin 
before removing a fore leg deviates somewhat from the manner 
described on page 271. 

He circumcised about three-fourths of the skin of the fore 
arm, a little above the carpus. After separating the skin a 
little above the wound with the thumb, the spatula is intro- 
duced to sever the connective tissues and all the muscles 
excepting the M. cuccularis. Next he cuts the remaining skin 
of the first incision, also the skin along the whole limb. After 
that three men exert traction. | 

Franck-Goring, after fixing the leg, split the skin on the 
internal surface of the limb and the superficial fascia from the 
sternum to the fetlock. They use the finger knife or chisel 
with concave cutting edge and a probe-point on each side. 
The balance of the skin is separated with the hand or spatula. 
After the skin is completely severed at the shoulder, the 
pectoral muscles are cut, the skin at the fetlock is circumcised 
and the leg extracted. 


AUXILLIARIES IN THE STUDY OF 
MECHANICAL OBSTETRICS. 


The young veterinarian in the beginning of his practice 
meets with many difficulties. Nobody expects and demands 
that he should be an experienced practitioner. He certainly 
is not yet an expert in practical obstetrics, and here the adage 
“practice makes perfect”’ holds true. Of course the basis for 
it is laid at college, so he may not be embarrassed when called 
to an obstetrical case. Instruction only cannot school him to 
such an extent that he directs a case of dystokia with as much 
dexterity and ease as a common surgical operation, for instance, 
tracheotomy. Nevertheless, the college may assist him a great 
deal in this respect, of decided value later ; as by the exercises 
on the phantom. 


THE OBSTETRICAL PHANTOM. 


Pelviarium is an imitation of the uterus, pelvis and vagina. 
It serves to recognize and adjust abnormal presentation as in 
embryotomy. 

The phantom of repositions (fig. 69) consists of the skeleton 
of a cow or mare in the standing posture. For the sake of 
greater solidity, iron rods are passed through the vertebral 
column and underneath the vertebrae, resting anteriorly upon 
two rods standing obliquely and posteriorly upon an iron 
tripod. Heavy band iron is placed along the linea innom- 
inata and symphysis, the same along the costal cartilages. 
The abdominal wall is made of leather; the latter can be 
removed. 

The uterus is made of ealf’s leather, tapered to fit the 
vagina. On the side of the uterus is a flap through which the 


calf is introduced. This flap can be closed. 
200 





OBSTETRICAL PHANTOMS 291 


The teacher, or whoever stands on the side of this flap, 
can place the calf into any position he sees fit, to be diagnosed 
and adjusted by the student. 

This phantom is valuable to students who wish to become 
dexterous in cording, adjusting and applying hooks. It may 
also be used in demonstrations ; for instance, the diagnosis of 
torsio uteri. 




















ae =a] ——= = > SSS = 





Fig. 69.—Phantom for the Study of Malpositions, 


THE PHANTOM OF EMBRYOTOMY. 


A practical and simple phantom is shown in fig. 70. It 
consists of a strong board with a round opening in front. 
The inner border of this opening is padded with leather. The 
part resting on the table has two iron pins fitting into two 
holes in the table. The board is held in place by two clamps. 


292 BOVINE OBSTETRICS 


A dead ealfis placed upon the table; the student, standing in 
front of the board, passes the hand through the opening, pulls 












Fig. 70.—Phantom for the Study of Embryotomy. 


a leg or head through it and performs embryotomy as already 
described. 




















Fig. 71.—Phantom for the Study of Embryotomy. 


A student purchasing this cheap phantom may become an 


OBSTETRICAL PHANTOMS 293 


expert in embryotomy. It has the advantage that all motions 
of the student are visible and may be corrected. 

Already in 1851 S. Witt, instructor in obstetrics, gave a 
course in embryotomy at the Utrecht school. For this pur- 
pose he had made a phantom (fig. 71), consisting of a bovine 
pelvis with the part of the vertebral canal, resting and fastened 
to a wooden frame. The position of the pelvis padded with 
leather corresponds to the one of a cow in the recumbent 
position. 

Uterus and vagina are represented by a sac of leather, 
with a flap on the side to introduce a dead calf. 

In the phantoms, newly born calves bled to death may be 
used. When the calves become several days old they may 
still be used, but the subcutaneous tissue has then become 
rather firm. 


DISEASES DURING AND FOLLOWING 
THE ACT OF BIRTH. 


1.—Sprains, Luxations and Fractures Following 
Parturition. 


When violent traction is practiced during dystokia, expos- 
ing the long pelvic canal to excessive pressure, many disturb- 
ances may arise. Sprains, mostly accompanied with partial 
rupture, usually concern the ligamentous apparatus of the 
sacro-iliac articulation. In this case there need not nec- 
essarily be a disturbed relationship between the sacrum 
and the external angle of the ilium, but the union of the pelvis 
with the trunk may have become less solid, leading to disturb- 
ances in position and walking of the animal. 

Causes.—This disease often follows when the interior half 
of the ecalf’s body is delivered by severe traction while the 
trochanteric diameter of the calf lies in front of the pelvic 
inlet. This traction spreads the greatest pelvic diameter, 
producing a stretching or even luxation of this rather immoy- 
able joint, since the internal angles of the ilia come further 
apart. This sprain may also follow strong traction on the calf 
with cow in the dorsal position. In lymphatic animals there 
is the possibility that when the abdominal pressure is active, 
already a limited traction may cause rupture, since the move- 
ment of this joint in such animals amounts to several milli- 
meters. 

When upward instead of downward traction is practiced 
on the calf, sprains are more readily caused. 

Symptoms.—The cow can rise only with difficulty. She 
sways to and fro, and when the hind legs are close together 
she easily loses her equilibrium and falls down; but when 


the hind legs have their normal position the equilibrium is 
204 





SPRAINS, LUXATIONS AND FRACTURES 295 


pretty well retained. When the cow attempts to plant a hind 
leg, it makes an impression as if the extensor muscles of the 
leg are paralyzed. At the moment the function of the support- 
ing leg sets in,* the fetlock knuckles over so that its anterior 
surface often touches the ground. 

When we place the foot against the anterior surface of the 
joint, knuckling can be prevented and the cow is able to bear 
weight on that leg. 

Course and Prognosis.—Observations indicate that a simple 
sprain, often only unilateral, with limited rupture of the liga- 
mentous apparatus, is usually followed by recovery. The 
prognosis becomes more favorable the better the animal can 
rise and stand. 

Absence of luxation between the sacrum and ilium allows 
us to predict recovery in two or three weeks. 

Nevertheless, many animals, which stood quietly in the 
stable and apparently recovered, showed a swaying walk as 
soon as they go to pasture, but improvement usually sets in 
after a few weeks of rest. 

Treatment.— When professional advice is requested imme- 
diately after parturition, the animal is to be placed on a 
horizontal floor and not on a place lower behind than in 
front, or where it may possibly slide into a gutter. The bed- 
ding must be of a nature to prevent the legs from getting- 
entangled. 

Further treatment is very simple. The animal is to be 
fed less voluminously but more intensively, and any eventual 
complications are to be prevented. Care must be taken that 
such an animal does not lie on its side, but rests upon the 
knees and sternum. The former, especially when lying on the 
left side, causes tympanitis. It happens that tympanitis dis- 
appears immediately, changing the general appearance of the 
animal, when the cow is placed on the knees and sternum. 
Many veterinarians order embrocations of ammonia or ol. 
terebinth, spirits of camphor, etc.,in the sacral and lumbar 
regions. These applications are useless and have only then 


* See my ‘Clinical Diagnosis of Lameness.”—W. E. A. W. 


296 BOVINE OBSTETRICS 


value when they induce the owner to execute the other and 
more rational orders. For that purpose it is well enough to 
prescribe them. 

It is advisable to rub the legs several times daily with a 
straw wisp to stimulate circulation. 

The udder must also be cared for. The cow must be 
milked cautiously and patiently several times daily. The 
bedding must be kept very clean, as a mastitis the result of 
infection often sets in, as she is milked while in the recumbent 
position. 

Lu«ation following parturition may involve the sacro-iliac 
articulation and coxo-femoral articulation. 


LUXATION OF THE SACRO-ILIAC ARTICULATION. 


The connection between the vertebral column and the 
posterior extremities is mainly established by this joint. The 
wings of the sacrum and the external angles of the ilia are in 
contact with each other to quite some extent. 

This joint can expand most during the act of parturition, 
since the postero external angles have an upward direction 
(oscillating movement of the pelvis). We noticed previously 
that Berdez first drew attention to the fact, that the relaxation 
of the broad pelvic ligament mainly depends on the elevation 
of the posterior part of the pelvis in the preliminary stage. 
This position is produced by the diminished traction exerted 
upon the pubis by the rectus abdominis muscle. 

Causes —Luxation usually follows as the result of too 
frequent upward traction during parturitiou, but also when the 
cow is raised with the tail after having given birth. According 
to Stockfleth, complete luxation follows muscular efforts. 

Symptoms.—The relation of the sacrum to the ilia has 
changed, the vertebral column has descended, so that the 
internal angles of the ilia project. The descended promon- 
torium is readily located on rectal examination. As a result 
of the rupture of the ligamentous apparatus a hemorrhage 
occurred ; even an extensive hematoma may be found there. 

At first the general health is somewhat disturbed, dis- 


SPRAINS, LUXATIONS AND FRACTURES 297 


appearing after a few days. Such animals usually cannot rise. 
When assisted they knuckle over at the fetlocks of the hind 
legs, remaining in the standing posture but a short time. The 
subsequent drawing shows a cow suffering with a limited 
luxation of the sacro-iliae articulation, the result of excessive 
traction during parturition (fig. 72). 

Prognosis and Qourse-—When the sacrum is but little dis- 
placed, it is possible that the cow gets up in eight to ten days 
and improves gradually but very slowly. 

At the same time it is impossible to ascertain how much 
union there is still between the sacrum and ilia; in fact, any 





= =O et a) SPD — 
Ry =. 


a 
Saye ie gre Sec 






He 


Fig. 72.—Luxation of the Sacro-iliac Articulation. 


attempt to rise may increase the rupture. The prognosis 
therefore must always be doubtful. 

There are cases where the dislocation amounts only to a 
few centimeters and where such a firm connective tissue union 
is established in two months that the cow can walk about 
nicely. From the standpoint of the breeder, it must be remem- 
bered that the height of the pelvic inlet is lessened in such a 
case. 

Stockfleth had a picture made of a sacro-iliac luxation 43 
days old which occurred the day after calving and where the 
displaced wings of the sacrum had become united with the 
posterior iliac angles by strong connective tissue. 


298 BOVINE OBSTETRICS 


Treatment.—Absolute rest and a horizontal position are the 
main factors. When a luxation is surmised the animal must 
not be forced to rise, but left in the reeumbent position. She 
should rest upon a horizontal bedding, upon the sternum, 
flexed knees and hocks. To prevent the animal from lying 
flat on its side, it should be banked up by straw. As regar(s 
medication, the same holds good as remarked when discussing 
sprains and partial rupture of the ligamentous apparatus of 
this joint. 

Luxation with partial rupture of the ligaments, as well as 
complete luxation of this joint, are often the cause that the 
animal remains down after parturition. 

Violent traction is not necessarily always the cause of it. 
Luxation may also follow aggravated contraction of the abdom- 
inal parietes, disturbing on the one hand the harmony between 
the rectus abdominis and psoas parvus muscles, and on the 
other the extensor muscles of the back. 


LUXATION OF THE COXO-FEMORAL ARTICULATION. 


This luxation sometimes follows dystokia indirectly. It 
may be caused when the hind leg lies under the body and the 
animal falling down while trying to rise; further, when she 
falls down while the hind leg slips outward at the same time, 
thus forcibly abducting the whole limb. 

Stockfleth saw a backward and inward luxation in a cow 
which had been raised with ropes fastened to the hocks, hang- 
ing mainly by one leg. Should an animal remain down atter 
parturition, this luxation must be remembered. 


FRACTURES. 


Pelvic fractures may follow dystokia when violent traction 
is practiced, the cow pulled from the bedding and lying lower 
with the hind quarters, when she falls down after having been 
raised with a great deal of trouble by pulling excessively on 
the tail to accomplish this object. The most common frac- 
tures involve one wing of the sacrum, and shaft of the ilium, 





INJURIES OF THE UTERUS, VAGINA AND VULVA 299 


obturator foramen and the ischium posterior to the cotyloid 
cavity. 

In all these fractures the cow cannot rise, or only with 
difficulty. With regard to their diagnosis, I refer to works on 
surgery. 


2.—Injuries of the Uterus, Vagina and Vulva. 


Various injuries of the uterus may occur during birth. 
The mucosa may only be involved, but also the muscularis and 
serosa. It is termed a penetrating wound, when all three 
layers are included. Eventration may or may not be present. 
Abdominal viscera may possibly pass through the wound into 
the uterine cavity, usually the colon or the omentum. Uter- 
ine injuries may be divided into spontaneous ruptures, small 
wounds in the pregnant cornu and in the cervix. 

Spontaneous ruptures are those which take place at the end 
of the period of gestation or during the act of parturition, 
without being caused by any interference from without. 

Causes: Torsio uteri (Albrecht). On account of the cir- 
culatory disturbances following torsio uteri, this organ is pre- 
disposed to rupture, which takes place readily on the slightest 
cause; but external injuries also may give rise to it, as seen in 
the case described by Albrecht, where abdominal hernia and 
a uterine rupture 30 cm. long followed the blow from a horn. 
Ruptures in the posterior segment of the uterus usually occur 
during the act of parturition. 

Tapken is of the opinion that, since in all probability the 
contractions of the bovine uterus—same as that of man—render 
it longer and more narrow, the muscular elements accumulate 
opposite to the cervical canal, this causing a stretching of the 
posterior uterine segment and possibly rupture. This view 
seems to be correct, since experience teaches that in certain 
positions of the foetus energetic uterine contractions predispose 
to rupture. Very often we observe in spontaneous rupture of 
the uterus a posterior presentation with the hind legs under 
the abdomen (Tapken, Strebel. Albrecht). I myself have seen 


300 BOVINE OBSTETRICS 


two cases of such a posterior presentation in practice, where a 
spontaneous rupture followed violent uterine contractions cur- 
ing exploration. 

Tapken reports a case of posterior presentation of a calf 
with the hind leg retained under the body. While adjusting 
the parts the cow suddenly made a violent move, followed by 
a considerable rent in the uterus. 

Spontaneous ruptures usually take place in the floor of the 
uterus within 10 cm. from the cervix, and always involve all 
three layers, showing a length of 20 to 30cm. andmore. They 
may be so large that the calf passes through them, lying free 
in the abdominal cavity. 

The diagnosis is not difficult. On exploration, the calf is 
found to have descended and the large intestines are usually in 
the uterine cavity. Close examination reveals the direction 
and extent of the rupture. 

Course, prognosis and treatment.—The course is acute. A 
violent peritonitis or internal hemorrhage usually causes death 
within a few hours. Those ruptures of the uterus which take 
place while the cervix is closed form an exception. It happens 
that obliteration of the os uteri is followed by rupture of the 
uterus and no air entering. Rupture the result of torsio uteri 
may also occur without entrance of air. Here the course is 
different. Such animals show the symptoms of an internal 
hemorrhage or subacute peritonitis, causing a fatal termination 
in due time. Since treatment is out of the question, the 
animal is to be slaughtered. 

Small injuries in the pregnant horn are often produced by 
rough manipulations while correcting a malposition, or by the 
slipping of the hook. These small injuries do not exceed 10 
em., and differ materially from the spontaneous ruptures. 
Among others, they may follow reposition of retained hind legs 
in a posterior presentation, when the fetlock is corded and 
pulled at, without repelling the foetus or resting the hand 
against it. In this rough method the fetlock of the calf rotates 
under the pubis, exerting such pressure upon the floor of the 
uterus that a rupture may easily take place. Rupture may 





INJURIES OF THE UTERUS, VAGINA AND VULVA 301 


also follow when the head of the calf is pushed back into the 
uterus to gain room, and forcibly extracting the fore leg from 
the skin (Tapken). 

The application of the obstetrical crutch may also lead to 
rupture of the uterus, when an assistant repels the calf and the 
instrument glides off. This instrument anyway may be readily 
dispensed with. Many veterinarians are of the opinion that 
rupture of the uterus, no matter from what cause, is especially 
frequentin fatcows. This depends probably on fatty infiltration 
of the tissues, thus lessening their powers of resistance. 

Symptoms.—Non-penetrating wounds frequently cause 
violent hemorrhages; at the same time they may be over- 
looked and become the source of a general infection. 

A phenomenon most conspicuous in penetrating uterine 
wounds is straining, pretty soon followed by symptoms of 
peritonitis, due to the septic uterine secretion which entered 
the abdominal cavity. 

The temperature is accordingly higher, usually 39.5 to 40 
degrees C.; but it frequently happens that there is no rise in 
temperature and only an increase in the pulse rate (above 100). 
The latter is an ominous phenomenon. The animal feeds but 
little, rumination is suspended and the lacteal secretion greatly 
diminishes. 

In fatal cases the belly is tense, and colicky symptoms 
appear. Small wounds in the roof of the uterus may heal, and 
do not give rise to marked symptoms. 

Course and Prognosis.—The course is favorably influenced 
by a rapid contraction of the uterus after birth. As a result of 
this, a uterine wound is decreased two-thirds already a few 
hours after parturition, which fact explains the favorable ter- 
mination of many cases of Cesarean sections where the uterus 
was sutured insufficiently. 

The prognosis in non-penetrating wounds is much more 
favorable than in penetrating ones, although the former may 
lead to a fatal termination when infected. 

Wounds in the region opposite the rectum are not soiled 
by the secretion of the uterus, and therefore allow us to give a 


302 BOVINE OBSTETRICS 


more favorable prognosis than those in the floor of the 
uterus. 

The danger of infection is always great when there is 
retention of the foetal membranes and a uterine wound. It is 
always well to give a doubtful prognosis even when the wound 
is but little. Penetrating wounds always demand an unfay- 
orable prognosis. 

Treatment.—When the afterbirth is not yet expelled, it 
must be removed immediately to encourage early contraction 
of the uterus. 

Non-penetrating wounds, when within reach of the hand, 
may be slightly cauterized. Nevertheless the main thing is to 
encourage involution. For this purpose a subcutaneous injec- 
tion of 5 to 8 g. of extractum secalis cornuti in 5g. of glycerine 
and 5 g. of water in one dose is advisable. In cases of violent 
hemorrhage the uterine cavity may be tamponed with jute 
saturated with a boracie acid solution. The tampon is retained 
by suturing the vulva and removal in eighteen to twenty-four 
hours. The uterine contractions expel the lochie, thus dimin- 
ishing the danger of infection. 

Irrigations of the uterus must not be practiced in super- 
ficial and penetrating wounds. Even in wounds of the first 
category irrigation may be dangerous, as the extent of the 
lesion is difficult to ascertain, and in consequence of high 
pressure the fluid may pass into the abdominal cavity. The 
reflex activity of the abdominal parietes may be counteracted 
by clysters of choral hydrate. 

Injuries of the cervix are most common in practice, 
especially at the so-called portio vaginalis, mainly in primi- 
pare. 

Causes.—The cervix uteri is easily wounded when the os 
is partially dilated and traction is exerted on the calf. Mostly 
the superior wall is injured, which is dilated until it finally 
tears. Rough attempts at reposition and the slipping of a 
hook may also cause such wounds. 

Symptoms.—Injuries of the upper wall do not give rise to 
special symptoms; only in deep wounds, extending as far as 


INJURIES OF THE UTERUS, VAGINA AND VULVA 303 


the excavation, eventration may follow straining. All penetrat- 
ing wounds, even without eventration, lead to peritonitis. 

Injuries of the inferior wall are followed by serious hem- 
orrhage; a great many cases of metrorrhagia depend on it. 
During the examination the squirting of the arteries can often 
be felt. The mucosa may be torn from the muscularis to quite 
some extent. This is frequently the case when the anterior or 
posterior half of the body is wedged in the pelvic canal, and 
the calf turned forcibly around its long axis. 

Course and Prognosis.—Injuries of the upper wall of the 
cervix not extending to the excavation usually heal. There is 
great danger of infection in emphysematous calves and in 
these where the afterbirth is decomposing. Under such cir- 
cumstances the prognosis is less favorable. 

Wounds which extend into the excavatio vesico-uterina, 
either with or without eventration, always force us to give an 
unfavorable prognosis. 

Treatment.—The essential point lies in the prevention of 
infection. For this purpose the secundines are to be removed 
immediately after birth, and contraction of the uterus is to be 
effected by a subeutaneous injection of extractum secalis. 

When in serious hemorrhage the artery can be grasped 
with the fingers it must be twisted or ligated. This is some- 
times possible. 

Should it be possible, the os uteri is tamponed with jute 
or cotton previously soaked in a boracie acid solution. Klin- 
kenberg (Holland) used in such a case six towels and one 
pound of jute; the vulva was sutured to retain the tampon. 
The tampon is removed in twenty-four hours. 

As a rule, the uterus has between times contracted sufti- 
ciently; when necessary, the injection of ergot of rye may be 
repeated. 

In small injuries of the cervix, local and antiseptic treat- 
ment suflices. 

It is evident that irrigations of the uterus must be omitted 
in penetrating wounds of the uterus. When a piece of the 
omentum has entered through the cervical wound into the 


304 BOVINE OBSTETRICS 


parturient passage it is drawn in further and severed. This is 
followed by agglutination and recovery, provided the uterine 
secretion is aseptic. 

Many veterinarians successfully order cold applications to 
the loins to encourage contractions of the uterus. 

Franck insists that in post partum paralysis the bruised 
uterus (cervix uteri) may reflexly produce paralysis of the pos- 
terior extremities. He states that this reflexory paralysis in 
one or both limbs, originating in the uterus, is also seen in 
man, and adds: “They frequently disappear on thorough 
cauterization of the offending portion of the uterus.” 

Schurink also describes a case in which post partum 
paralysis was due to injury of the uterus. 


INJURIES OF THE VAGINA. 


Most injuries of the vagina take place during parturition. 
They may occur when extraction is attempted during violent 
pains with the calf in an abnormal position. With one fore 
leg flexed at the carpus and retained, and the other leg and 
head lying normally, limited traction suffices to tear the vaginal 
wall, already tense. Rough manipulations during reposition 
may cause injuries. 

A common cause of vaginal wounds is the slipping of the 
hooks or injury by sharp pieces of bone, the result of em- 
bryotomy. 

Symptoms.—In many cases the wound is only detected on 
vaginal exploration. Penetrating wounds are characterized by 
a more general disturbance, wanting appetite, straining and 
symptoms of peritonitis. 

In eventration a piece of the omentum is mostly found in 
the vagina, especially when the wounds are in the lower wall 
and near the external os uteri. In those cases the owner 
calls the veterinarian because he sees a piece of fat, often 5 em. 
wide, protruding from the vulva. 

Large penetrating wounds may be followed by a prolapse 
of the intestines. Eventration increases on account of the per- 
sistent straining. 


INJURIES OF THE UTERUS, VAGINA AND VULVA 305 


Wounds in front of the opening of the urethra and extend- 
ing into the excavatio may cause dislocation (prolapsus) of the 
bladder, which protrudes and lies in the vagina. The neck of 
the bladder is stretched and micturition rendered difficult. As 
a consequence the urine accumulates, this dislocation shortly 
leading to rupture of the bladder. 

Wounds in the upper wall may involve the rectum, and feces 
drop through the opening into the vagina. These wounds are 
usually close to the upper commissure of the vulva, 

When the vaginal wound becomes infected, either by direct 
inoculation, as is the case in emphysematous foetuses, or infec- 
tion takes place later through decomposing uterine secretion, 
other phenomena offer themselves. 

Under those circumstances a diffuse swelling of the labiz 
is first noticed. It usually sets in at the third or fourth day 
and is not only limited to the vulva but also to the submucosa 
of the vestibule and vagina. The vagina is swollen so that the 
hand is passed in with difficulty. The examination is very 
painful to the animal ; a great increase in temperature is plainly 
felt. A dark-colored, stinking fluid flows, as a result of the 
swelling, from the vulva. Micturition is difficult, the urine being 
discharged frequently and in small quantities. The swelling 
about the rectum may mechanically interfere with defzecation. 

At first the general health is but little disturbed. As 
infection progresses, high temperature, increase in respiration 
and pulse rate set in, appetite and rumination diminish, the 
lacteal secretion is limited. 

Course and Prognosis.—The course of superficial wounds of 
the uterus is favorable, provided involution of the uterus is 
normal. At the same time vaginal wounds occasionally ter- 
minate favorably in spite of a decomposing afterbirth, due to 
the fact that the wound was filled with granulation tissue—an 
excellent protection—at the time infection might have taken 
place. 

It is further observed that putrefactive bacteria need not 
necessarily always infect a wound ; nevertheless, they prepare 
the medium for streptococci. This explains why vaginal 


306 BOVINE OBSTETRICS 


wounds—even small ones—are so dangerous when an emphy- 
sematous foetus or decomposing secundines are present ; simply 
because the protecting granulation tissue is wanting. 

Penetrating vaginal wounds in the upper wall, 13 cm. or 
more away from the superior commissure, or when in the 
lower wall in front of the urethral opening, are judged less 
favorably. In either case they involve the peritoneum. Exper- 
ience teaches that wounds without eventration, and even 
wounds where a portion of the mesentery lies in the vagina, 
may heal with proper treatment, but the prognosis must be 
guarded on account of an eventual infection. 

Treatment.—Of primary importance is the prevention of 
infection, and further to hasten the process of involution. The 
secundines must be removed when still in the uterus. Smaller 
wounds are treated locally and antiseptically. Whenever pos- 
sible, penetrating wounds of the upper wall are sutured. In 
eventration of the mesentery the same treatment is pursued as 
suggested under wounds of the cervix. 

When a prolapsus vesicze is present and the distended 
bladder lies in the vagina, it must be punctured with a trocar 
and emptied, followed by its reposition and stitching of the 
vaginal wound. Wounds which extend into the rectum may 
cause a recto-vaginal fistula. With regard to it, I refer to 
special surgery. In case a foetus has been wedged in the 
vagina for some time, the walls of this canal may be exposed to 
such pressure that the circulation, and in consequence of it 
nutrition, is disturbed. 

This is observed in cases where the anterior extremities of 
the calf are born and where an attempt was made to extract 
the hind parts forcibly. When parturition is completed by 
partial embryotomy, more or less necrosis of the mucous 
membrane of the vagina, the result of the pressure, manifests 
itself within a few days. We observe gangrene, decubitus of 
the vaginal wall. A phenomenon preceding the expulsion of 
the necrotic mucosa, is the swelling of the vagina and vulva, 
interfering with micturition, urine being evacuated frequently 
and in small amounts. 





INJURIES OF THE UTERUS, VAGINA AND VULVA 307 
The swelling diminishes in four to five days, a stinking 
fluid flowing from the vulva. Examination reveals that the 
leather-like mucous membrane has become detached here and 
there, granulation tissue being visible underneath the crusts. 
In about ten days the necrotic mucosa is expelled and the 
internal wall of the vagina shows a granulating surface covered 
with a small amount of creamy pus. The membranes are to be 
cut off or removed with the fingers, and warm antiseptic solu- 
tions should be injected, such as 2 per cent. carbolie acid or 
creolin solutions, followed later by a 2 per cent. alum solution. 
In consequence of the retraction of the granulation tissue, 
the lumen of the vagina is decreased and the elasticity of the 
vaginal walls lessened, so that such a spot often forms an 
obstacle to future birth. 


INJURIES OF THE VULVA. 


In dystokia, excoriations of the vuiva are frequently met 
with. They are the result of the tension to which the labize 
are exposed during passage of the calf. The subcutis, the 
muscular layer and the mucous membrane are more elastic 
than the skin. 

A vulva which is too narrow is often ruptured, the superior 
commissure being mainly involved in primipare. Wounds on 
the lateral surfaces of the labia are caused by rough manipula- 
tion, by instruments and projecting bones after embryotomy. 

Although the wounds of the vulva are less important than 
those of the vagina and uterus, the danger of infection is never- 
theless present. During the puerperal state quantities of 
pathogenic low organism and their media are discharged, thus 
offering ample opportunity for septic infection. This danger 
is partly lessened after the wound once granulates. 

The superior commissure may rupture to such an extent 
that the perineum is torn in a vertical direction; in such a 
case the feces drop into the vestibule—a serious complication 
unless quickly attended to. 

Treatment.—Any injury of the vulva, no matter how insig- 
nificant, demands attention. The labizw are cleansed with 


308 BOVINE OBSTETRICS 


soap and warm water and the small wounds slightly cauterized. 
For this purpose a 5 per cent. chloride of zine or 5 per cent. 
carbolie acid solution is employed. It is also advisable to 
paint the wound with tincture of iodine. Wounds which 
extend through the skin or mucous membrane into the mus- 
cular layer, are cleansed, freshened and stitched. The suture 
is covered with iodoform collodium or traumaticine. 

Injuries through the perineum into the rectum are cleansed 
and made into fresh wounds by removing all necrotic tissue 
and scarifying the edges of the wound. Next, the upper wall 
of the vestibule is sutured with strong silk, and then the outer 
skin. It sometimes happens in protracted labor, when the 
labize are rendered tense for a long time, that the vulva swells 
enormously. This may depend on a hemorrhage underneath 
the skin, in the elastic tissue or muscular layer (hematoma). 
Circulatory disturbance, especially venous stasis, may also 
produce it. 

The hematoma, usually unilateral, may be underneath the 
skin or mucosa. The coagulated blood is removed by an incis- 
ion and the cavity irrigated with an antiseptic solution. 

Swelling of the vulva, due to venous stasis, involves both 
labize. It increases when the animal remains down (hypostatic 
cedema). Gangrene, usually confining itself to a small part of 
the mucous membrane, or skin, may also follow circulatory 
disturbances. Necrosis of a triangular piece is sometimes 
observed, its basis lying in the mucous surface of a labia and 
the apex in the muscular layer. This circumscribed necrosis 
is due to thrombosis, interfering with the nutrition of that 
tissue, 

The treatment of the cedematous vulva consists in encour- 
aging circulation by keeping the animal standing. It is re- 
markable how soon large swellings of the vulva will disappear 
in this way. In a few hours already the skin of the vulva 
becomes wrinkled, due to an equalized circulation and decrease 
of the swelling. When the cow cannot stand, the hind 
quarters must be elevated; the latter ought to be done anyway. 
Some veterinarians employ stimulating remedies, as applica- 


PROLAPSUS OF THE UTERUS 309 


tions of spirits of camphor, tincture of arnica, ete. It is not 


advisable to chill the vulva; in fact, washing it with warm 
milk is useful. 


3.—Prolapsus of the Uterus. 
Uteri. 
Definition.—By prolapsus of the uterus is understood that 


change in the position of the gravid uterus where the impreg- 
nated horn is inverted and eventually appears without. 


Inversio et Prolapsus 


1 
) 
vr 
iy 
é 





Fig. 73.—Prolapsus Uteri in various stages. 


As long as the inverted part does not project from the 
vulva, an inversio uteri exists. When the inversion progresses 
and pushes the uterus out of the vulva, it is termed prolapsus 
uteri, or, better, inversio et prolapsus uteri. In the latter the 
uterus may protrude partly or entirely from the vulva. 

The above schematic sketch shows the inversion in 
various stages (fig. 73). In many instances the empty horn is 


not inverted. In those cases one finds a slit-like opening on 


310 BOVINE OBSTETRICS 


the lateral wall of the gravid and prolapsed horn, leading into 
the empty cornu. 

Prolapsus uteri is frequently seen in the cow, especially 
in lymphatic, excessively-fed and old animals, which have 
calved repeatedly; it is comparatively rare in properly fed 
young animals. 

Tt follows difficult and normal labor, also the partus prema- 
turus, and may occur any time after the calf is born until the 
cervix utericloses. As long as the cervix uteri is sufficiently 
dilated to allow the hand to pass, inversion and prolapsus are 
still possible. 

Causes.—They may be divided into two main groups: 
predisposing and direct causes. 


PREDISPOSING CAUSES. 


(a) Relaxation of the mesometrium. One must not think 
that the broad ligaments are stretched to such an extent that 
they participate in the whole displacement of the inverted horn. 
In a complete prolapsus only one half of their normal length 
is involved, as they are closely attached to the body of the 
uterus and do not carry but a small portion of the pregnant 
horn. Therefore one half of the length of the inverted horn 
may project at the’ vulva before the broad lgaments are 
stretched at all. 

(b) Sloping position. This induces a displacement of the 
uterus toward the posterior portion of the abdominal cavity. 
It also causes violent after-pains, in which the abdominal mus- 
cles are actively concerned, thus rendering it possible that 
the floor of the impregnated horn becomes inverted by the 
pressure of the abdominal viscera. Into the space thus created 
more intestines crowd, increasing inversion and prolapsus. 

(c) Insufficient uterine contractions. As a result of this the 
cervix uteri remains open after parturition, permitting easy 
passage of the inverted horn. The surface of the dilated horn 
is besides much greater, so that the probability of an inversion 
under such circumstances is greater than in a contracted state 
of the uterus. 


PROLAPSUS OF THE UTERUS Sil 


Violent straining or a sloping position behind, together 
with insufficient contraction of the uterus, are especially favor- 
able to inversion (Franck). Strong contraction of the uterus 
does not encourage inversion, but prevents it, on account of the 
closure of the cervix uteri. The malposition depends on the 
straining and displacement of the abdominal viscera toward 
the pelvic cavity, leading to inversion of the uterus. 

(d) Relaxation of the broad pelvic ligaments. In cows 
which have calved repeatedly the broad pelvic ligaments are 
often relaxed. In such animals, when lying low behind, pro- 
lapsus vagina occasionally is observed. In consequence of 
this the uterus may be drawn into the pelvic cavity after partu- 
rition becomes inverted, terminating in an inversion, when 
straining is severe. 


DIRECT CAUSES. 


(a) Aspiration during parturition (Franck). When severe 
tractionis exerted upon a large foetus, so that it is delivered with 
efforts inch by inch, it may happen that after the hind parts of 
the calf have passed the pelvic outlet, the cotyledons of the 
eravid horn present themselves already in the vulva. Active 
straining is then sufticient to expel the inverted uterus. 
Irrespective of aspiration, the prolapsus may in such a ease be 
due to the pulling on the after-birth when a good deal of it is 
wedged in between the calf and pelvic wall. Aspiration may 
take place (as Franck correctly states) when the entire or nearly 
all of the foetal waters were discharged previous to traction. 
As a consequence, the uterus clasps the calf firmly and during 
its passage inversion, and later prolapsus, is apt to follow. 

(b) The weight of the secundines. This is certainly the most 
direct cause. After parturition the secundines are still con- 
nected with numerous cotyledons, only a portion hanging from 
the vulva. The more foetal placentz become detached, the 
larger the piece hanging from the vulva and the greater the 
traction exerted upon the cotyledons which are still united. 
When the adhering placente lie in that portion of the horn 
turned toward the abdominal cavity, it may be readily inverted 


312 BOVINE OBSTETRICS 


by the weight of the foetal membranes (Harms). Even a slight 
inversion gives rise to straining, pushing the intestines against 
the inverted uterus, thus increasing the inversio uteri. 

As arule the placentze separate in time and the pending 
danger is over; but when the foetal and maternal placentz are 
firmly united, inversion is very likely to occur. 

When the afterbirth is expelled and the uterus contracted, 
so that the cervix is closed, there is no longer any danger of 
prolapsus. At the same time, I have seen, that two hours 
after the secundines were expelled and everything had taken 
a normal course, inversion and prolapsus occurred. It was 
due to a sloping position and insufficient uterine contrac- 
tions, in consequence of which the cervix uteri remained wide 
open. 

(a) Symptoms of inversio uteri without prolapsus. The feeun- 
dated horn is inverted and the inverted part pushed into the 
cervix or vagina. The owner usually furnishes the following 
history : “The cow calved a few hours ago (or sometimes on 
one of the preceding days). After a while she began to strain 
more and more in short intervals. The general health is dis- 
turbed; the cow does not eat or chew the cud, and is only 
induced with difficulty to rise.” 

Examination.—On vaginal exploration the hand feels a 
round mass in the vagina or cervix. Close examination reveals 
it to be the uterine mucosa with the cotyledons. It may 
happen that the inverted uterus is wedged in the vagina (Neid- 
harilt), or the cotyledons may be visible between the labiz. 

During the examination the cow strains violently, interfer- 
ing with the passage of the hand. This invagination of the 
uterus, often but limited, causes continuous straining. The 
condition can only be diagnosed by an internal examination, 
thus preventing an otherwise fatal termination. 

(b) Symptoms of inversio et prolapsus uteri. Its diagnosis is 
easy. One notices behind the cow a pear-shaped tumor hang- 
ing out of the vulva, becoming gradually wider, finally having 
the shape of a bean. In the standing cow it reaches as far as 
the hocks. 


PROLAPSUS OF THE UTERUS 313 


The surface formed by the mucosa shows the cotyledons, 
which are sometimes still connected with the foetal placentz of 
the chorion, so that the foetal membranes surround the inverted 
uterus like a sac. In a complete prolapsus the vagina ‘is 
always inverted, showing about four inches from the vulva, the 
palma plicata appearing like a wide band all around the 
inverted part, being narrowest right here (fig 74). 

After removal of the secundines the mucous membrane 
looks dark red, due to the influence of the air and yenous 
stasis. The older the inversion the greater the changes which 





Fig. 74.—Prolapsus Uteri. 


take place. After a few hours the mucosa is of a bluish-red 
color, showing dark spots here and there; these must not be 
looked upon as due to gangrene. They depend partly upon the 
disturbed return flow of the blood and partly on submucous 
hemorrhages (hematomata). When the prolapsus is permitted 
to hang any longer, cedema of the submucosa and muscularis 
and finally gangrene set in. 

Prolapsus following abortion is not as extensive as the one 
following ordinary labor. The dimensions of the prolapsus 
correspond with the size of the uterus at the time of pregnancy. 


314 BOVINE OBSTETRICS 


When inversion and prolapsus occur some days after birth, 
the dimensions are also less than when immediately following 
parturition. I know of a case where prolapsus uteri took place 
six days after birth, the afterbirth having been retained. The 
prolapsed portion was about one-half the size of the complete 
prolapsus previously described. 

In those cases observed by me the prolapsus only involved 
the gravid and inverted horn. Inversion of the empty horn is 
mentioned by some professional men. 

The general health is materially disturbed. The cow 
strains constantly, both when down and standing, defecates 
frequently, soiling the uterus. When considerable blood has 
been lost, the animal usually remains in the recumbent position 
and the mucous membrane of the mouth is pale. 

Prognosis.—This depends on many circumstances, and the 
following points are to be considered : 

1. How long does the prolapsus exist and what changes 
have taken place? When the prolapsus is only of recent date 
and the secundines still attached to the cotyledons and no 
injuries are present, the prognosis is favorable, but becomes 
less favorable when cedema of the uterus is extensive. 

2. Should the ‘examination reveal superficial wounds, the 
prognosis is doubtful, as infection may take place. Perforating 
wounds demand an unfavorable prognosis, especially when due 
to treads of a neighboring cow. Veterinary literature mentions 
cases where uterine injuries in a prolapsus healed after reposi- 
tion. A favorable factor is the contraction of the organ after it 
is returned to the abdominal cavity; by it large wounds become 
smaller and small wounds close entirely. 

3. What treatment has the prolapsus received so far? 
The veterinarian is not always the first one to lend a helping 
hand. Before his arrival, the owner or an empiric have often 
exhausted their skill, and not always in a cautious manner. 
Therefore the whole prolapsus must be carefully searched for 
any wound and must be examined whether any cotyledons are 
torn off or perforating wounds exist. The prognosis depends 
on the results of the examination. 


PROLAPSUS OF THE UTERUS 315 


Treatment.—Reposition and retention of the prolapsus are 
the points. Before reposition is attempted, certain prepara- 
tions must be made, which never should be omitted, as the suc- 
cess of the operation depends entirely on them. 

1. Preparation. When the veterinarian is called to attend 
a cow with prolapsus uteri, he usually finds on entering the 
stable that the cow lies on her side, the hind parts often lower, 
and that the owner keeps the inverted uterus covered as much 
as possible with cloths. The operator now undresses suflici- 
ently to have the arms bare and removes any closely fitting 
dress which interferes with free movements. The cow is now 
straightened—that is, placed upon the knees and hocks or upon 
the right side. Two strong men take care of the head, another 
one pulls the tail to one side. This is followed by 

2. Removal of. the secundines. When they are still adhering, 
it is always a proof that the owner has not attempted repos'- 
tion. The removal of the afterbirth is very simple. The foetal 
placenta is stripped off each cotyledon with the thumb and 
index finger. After all cotyledons have been treated in this 
way the hand is passed into tne slit-like opening leading into 
the empty horn, where the chorion is also separated from the 
cotyledons. The secundines are now removed, the inverted 
uterus rinsed with cold water and placed upon a clean cloth. 

3. The hind parts of the cow are raised, or whenever pos- 
sible she is induced to stand up. Anybody omitting this meets 
with difficulties. Many a young veterinarian found to his dis- 
advantage that he omitted this, the first and ost important 
rule of reposition. I am almost tempted to state that the bal- 
ance of the treatment depends entirely on the execution of this 
rule. The greater the elevation of the hind parts of the cow, 
the easier the reposition. In the standing posture the con- 
ditions are very favorable, especially when the cow lies on the 
knees in front. Whenever possible the cow should be placed 
in that position, as it is the best one for the operator. While 
doing so the cow must be supported by placing a rope or sack 
under the sternum, to be held by two men, two more when sup- 
porting her behind in a similar manner without pushing the 


316 BOVINE OBSTETRICS 


belly up. When the cow is unable to stand or falls down 
constantly, thus exposing the uterus to injury, she is laid down 
and che hind parts raised. Many operators prefer to place the 
cow upon the right side, at the same time elevating her behind. 
I have aiso succeeded in practicing reposition in this way. In 
case this position is employed, the long axis of the cow and the 
floor should form an angle of 30 to 45 deg. The hind parts are 
easily raised by using bundles of straw, tied with three ropes, 
thus preventing the cow from sliding. In order to place the 
bundles easily, a girth is pushed under the body, two men on 
each side now raising the cow. An assistant puts the bundles 
in place while the veterinarian protects the inverted uterus 
from injury. Another simple method is the following: The 
cow is laid upon a door; a few men raise the door behind, 
placing the straw under t, thus elevating those parts (Harms, 
Goring). 

As a result of the elevated state of the hind parts, the 
intestines slip forward, rendering reposition more easy. It is 
very reasonable, therefore, that many practitioners have pro- 
posed methods to render this important preparation more easy. 
Schmidt's method is very good.. The animal rests upon the 
sternum, abdomen and hind legs flexed on the belly—that is, the 
posterior limbs are flexed in the tarsal joints so that the animal 
rests upon them and the posterior face of the metatarsal 
bones. 

Others recommend to put the cow on the back and elevate 
the hind parts (Harms). For this purpose the thighs of the 
hind legs are corded and fastened to a strong stick placed 
transversely. Four men, two on each side, raise the cow while 
an assistant banks her up with bundles of straw. The cow, 
while in the dorsal position, may also be wound up as done by 
the butcher, the withers only touching the ground (Franck). 
This is a pretty rough method, but in it reposition is easy. 
When reposition is impossible by any of the previously men- 
tioned methods, this last named method may be practiced. 

teposition therefore is practiced in the standing cow— 
either resting on the knees or not—upon the right side with 


PROLAPSUS OF THE UTERUS 317 


the hind parts raised, or in the dorsal position with the hind 
parts elevated. 

Reposition is not attempted when the cow lies on the left 
side, the cow being first rolled onto the right side. The 
diagonal position of the rumen explains sufficiently why 
reposition meets with great difficulties, or is even impossible, 
with the cow resting on the left side. 

4. Treatment of the prolapsed uterus previous to reposition. 
Careful cleansing is indicated, best done with cold antiseptic 
solution of lysol or creolin; the cold at the same time stopping 
hemorrhages. The use of warm milk or oil is absolutely 
superfluous. 

Quite some patience is necessary to clean the uterus thor- 

oughly and to remove all bits of straw, ete., in the folds. 
: Small wounds are stitched with strong thread, the stitches 
going through the mucosa and muscularis. The edges of the 
wound are bent so that the edges of the mucous membranes 
project upward when the suture is completed. This assures 
apposition of both serosz. Reposition must be done cau- 
tiously. As soon as the uterus is replaced, it contracts, thus 
rendering the wound smaller. 

The uterus is next placed into an alum bath—that is, 
moistened for about ten minutes with a 2 or 3 per cent. alum 
solution. For this purpose 200 g, of alumen are put into 101. 
of water. This treatment, first introduced by Weidenkeller in 
1852, has the following advantages: The alum has antiseptic 
and astringent properties ; the mucosa becomes rough, so that 
the surface of the prolapsed part is more readily grasped dur- 
ing reposition; the alum solution also causes the uterus to 
contract a little, thus diminishing it in size. The treatment 
may also be executed by enveloping the prolapsed uterus with 
cloths previously saturated in the alum solution. This alum 
treatment is very useful indeed. 

After all preparations have been thus made, follows: 

5. Reposition. It endeavors to return the inverted organ 
to the abdominal cavity. Many methods are employed, one 
using this one, others another one. Success mainly depends 


318 BOVINE OBSTETRICS 


on the fact that the preparations have been carefully performed. 
The method most commonly employed is that one where the 
operator begins at the opposite direction in which the pro- 
lapsus took place. The uterus for this purpose is again 
inverted upon itself. 

Modus operandi.—The uterus is placed upon a sieve, or 
instead of it upon a broad cloth, and elevated by two assist- 
ants, one on the right and the other on the left side of the 
surgeon. After seeing that the uterus has not rotated around 
its long axis, occasionally the case when the cow is rolled, the 
fist, covered with a cloth, is placed against the most dependant 
part of the inversion, reinverting the uterus by slow and 
gradual pressure. While doing so the fist moves in the direc- 
tion of the long axis of the impregnated horn toward the vulva. 
It is imperative to follow that direction. Those who practice 
reposition of the prolapsus uteri sometimes forget this rule, 
pushing the inverted uterus against the ischium, unable to 
proceed further ; this also is apt to produce rupture. 

While pushing the uterus further and further with the 
hand, one endeavors to advance as far as possible, especially 
when the cow does not strain. This pressure must be prac- 
tised slowly and gently, and that portion of the uterus lying 
on the arm is seen to return gradually. It is frequently neces- 
sary to retract the hand, the arm being too short to advance 
further. In order to do so an assistant presses against the 
uterus while the operator’s hand is retracted to take a new 
hold. 

When the horn is reduced and the hand passed in as far 
as possible, the upper portion of the arm is still in contact with 
the prolapsed cervix vagina. To reduce them, two assistants 
press against the prolapsed parts on either side of the vulva 
with their hands protected by towels, reposition taking place 
usually quite easily in the intervals between the straining, the 
whole mass mostly slipping in all at once. During this opera- 
tion the cow strains constantly; it may become so violent as 
to interfere greatly with reposition. Many practitioners very 
properly are of the opinion that the intervals of rest between 


PROLAPSUS OF THE UTERUS 319 


the pains should be used to advance the hand and perform 
reposition. Others recommend chloral hydrate per os (Proger) 
or a whiskey narcotic. 

Some practitioners perform reposition in a different 
manner. They grasp with both hands that part of the pro- 
lapsus next to the vulva, pushing it in, while assistants manipu- 
late the remaining portion of the prolapsus similarly. 

This method may be combined with the first one. After 
that portion close to the vulva has been returned, the fist is 
placed against the basis of the prolapsus, reducing the whole 
mass (Goring). 

Coculet proposes a method to decrease materially the 
dimensions of the prolapsus previous to reposition, so that it is 
reduced with but little effort. After cleansing the uterus, it is 
wrapped in a piece of linen 1 m. long and 70 cm. wide. The 
uterus is now continually irrigated with warm water, drawing 
it tighter from minute to minute, thus diminishing its volume 
constantly. Reposition is readily effected after fifteen to 
twenty minutes. 

This method, combined with the alum brentmede: is to be 
recommended, as it saves a lot of work and decreases danger. 

After treatment.—Reposition must be complete ; that is, 
eare should be taken not to overlook partial inversions here 
and there, which induce straining and possibly a new prolapsnus. 

To prevent this the cow ought to be made to rise immedi- 
ately after reposition. The hand is introduced into the uterus 
to smooth down any remaining wrinkles, which, as a rule, have 
disappeared by themselves. It is also well to walk the cow, as 
exercise is the best means to encourage complete reposition 
and to prevent straining. 

When the cow is unable to rise, the hind parts should be 
raised and the hand remain in the uterus for ten to fifteen 
minutes. As long as the uterus is not completely descended 
into the abdominal cavity and it pushes continually against the 
hand, something is wrong. In those cases the hind parts are 
to be raised more yet, or she is to be made to stand, according 
to Johne’s method (I. ¢.). Some recommend to fill the uterus 


320 BOVINE OBSTETRICS 


with fluid, as warm water or a weak lysol or creolin solution, to 
smooth down any wrinkles. For this purpose I suggest a 1 per 
cent. alum solution, provided no uterine wounds are present. 
After a complete reposition the cow does not strain any more, 
and should she continue to strain, an exploration must be made 
at once to correct any partial inversions. 

It often happens that when the owner reduces the pro- 
lapsus himself the cow continues to strain in spite of all means 
employed to prevent it (curry-comh tied to the back, surcingle 
or bandage around belly), professionali aid only being employed 
after a few days, when the general health becomes disturbed. 
Internal examination then reveals that an inversio uteri is 
present, cotyledons lying in the cervix or in the vagina. 

In those cases the treatment is as follows: The well-oiled 
hand repels the inverted part, followed by immediate walking 
exercise of the cow. After that the uterus is irrigated once 
daily with a warm alum solution; when necessary, a pessary 
is employed. 

The quicker the contraction of the uterus and closure of 
the cervix after reposition, the less the danger of a recurrence. 
Therefore, little pieces of ice are frequently introduced into the 
uterus to encourage contractions. The main point in the after 
treatment therefore consists in the prevention of a new pro- 
lapsus, most readily effected by a complete reposition. There 
are many means employed to prevent it, which may be divided 
into two main groups: (1) means which prevent inversio uteri ; 
and (2) means which only prevent the expulsion of the pro- 
lapsed uterus from the vulva. 

To the first group belong the pessaries. They prevent 
the inverted uterus from passing through the cervix into the 
vagina. 

St. Cyr and Violet describe a simple pessary, termed by 
them Gariel’s pessary, consisting of a rabber pouch and tube. 
The pouch is folded, introduced into the uterus, inflated and 
closed by means of a small stopcock. The whole is a modifica- 
tion of Willburg’s pessary (Baumeister), he introducing a pig’s 
bladder and inflating it. 


PROLAPSUS OF THE UTERUS yall 


St. Cyr and Violet state that the pig’s bladder for this 
purpose was mentioned already in 1815 in the “ Cours d’agri- 
culture de l’ablé Rozier, II. ieme édit. Paris, 1815, Tome I, 
Article accouchement.” Rainard reports that Greek veterin- 
arians of the Roman Empire (300) already used a pig’s bladder 
as a pessary for said purpose. 

It is also possible to prevent the inverted uterus from 
passing into the vagina by tamponing the vagina. Already 
Chaber (1795) and Leblanc (1826) described pessaries for that 
purpose. 





Fig. 75.—Rainard’s Truss. Fig. 76.—Lund’s Iron Truss, 


Also a stick with a knob, the latter enveloped with cloth, 
may be used as a pessary. The knob is introduced as far as 
the cervix, where it remainsfor sometime. The end projecting 
from the vulva is fastened by means of two cords (one on each 
side) to a surcingle. 

Pessaries may be dispensed with in our practice. In many 
cases they are a disadvantage, causing violent straining, 
metritis or injuries. 

Among the means employed to prevent the prolapsed 
uterus from being expelled are: 1, suturing of the vulva (see 
prolapsus vagina) ; 2, trusses. 


323 BOVINE OBSTETRICS 


Trusses are variously shaped. They mostly consist of 
ropes lying on either side of the vulva and pressing against it, 
secured to a surcingle. The adjoining drawings show some of 
those employed (figs. 75, 77). 

Lund constructed a very practical truss (fig. 76). Brauer’s 
truss is used in cows where the vulva and anus lie deeply 
between the ischial tuberosities. The instrument for this 
purpose is well concaved. Although these trusses are com- 
monly used in practice, T prefer to suture the vulva. The latter 
is more likely to prevent a prolapsus, when the stitches are 





Fig. 77.—Truss commonly used in Holland. 


inserted sufficiently far from the free border of the vulva, than 
trusses which are easily displaced and get loose when the cow 
strains, and it happens that a portion of the inverted uterus 
passes by the truss. Another great disadvantage of trusses is 
the fact that they must remain for several days, eventually 
becoming a mass of manure. 


AMPUTATION OF THE UTERUS (AMPUTATIO UTERI). 


Indications —1. Gangrene of the uterus. Previous to this 
it was pointed out that not every black spot upon the uterine 


PROLAPSUS OF THE UTERUS 323 


mucosa should be looked upon as gangrene. A uterus pro- 
lapsed only a few hours is not yet gangrenous. At the same 
time itis found where prolapsus follows embryotomwy, wnere 
the uterus was wounded, or where rough attempts at reposi- 
tion of an abnormal presentation were made, in consequence 
of which the animal strains continually. At first an inver- 
sion occurs, possibly wedged in the cervix or vagina; finally 
prolapsus takes places. It also happens that reposition of a 
prolapse is followed on the next day by another one. In such 
cases gangrene is sometimes seen. 

2. Uterine wounds. Large wounds or those produced by 
treads of a neighboring animal penetrating the three layers 
indicate amputation. 

3. Impossibility of reposition. This indication,is rare. In 
most cases—in fact, in all cases—reposition of the prolapsus is 
possible. Amputation is only then indicated when all methods 
have been employed in vain. As a rule the uterus is then 
in a condition where its reposition would endanger the life 
of the animal. Under such circumstances amputation is called 
for. 

Prognosis. —When veterinary literature is consulted along 
this line, we notice that most animals stand the operation well. 
This deduction is not quite correct. The cow may stand 
amputatio uteri when artfully performed very well, and may 
suffer but little. But many cases are known where amputation 
was soon followed by severe disturbances, and even death. 
Some surgeons observed immediately after the operation great 
restlessness or paralysis of the hind parts. This usually 
lasted one half to one hour, eventually followed by improve- 
ment. I have seen such a state of excitement terminate fatally 
in one half hour. Prognosis therefore is doubtful. 

Modus operandi.—Before the operation is performed we 
satisfy ourselves that the urinary bladder is empty and that no 
intestines are lodged in the prolapsed uterus. When neces- 
sary, the bladder is emptied, the intestines are put back into 
the abdominal cavity by raising the uterus and elevating the 
hind parts of the cow. On the whole, intestines are rarely pres- 


324 BOVINE OBSTETRICS 


ent in the uterus. In doubtful cases an incision is made and 
the parts explored with the hand. 

The operation consists in ligating the prolapsus as a 
whole. For that purpose a broad ribbon is employed, placed 
around the cervix uteri with a surgical loop; a good-sized 
strong rubber tube may also be used. . 

Many empirics in Holland used a silk necktie for this pur- 
pose, tightening it around the cervix. 

Two points must be observed: 1, the site of the ligature ; 
9, the tightening of the ligature. 

Most operators ligate a few centimeters posterior to the 
palma plicata; only a few ligate the vagina. The first place is 
preferable, as there is no danger of including the urethra. 

In order to tighten the ligature properly it is necessary 
that it be strong, so that two men can pull on it with all their 
power; and, on the other hand, that it is sufficiently broad to 
prevent cutting through the uterus. 

The mass enclosed by the ligature is so large that it is 
somewhat difficult to cut off the entire circulation, which at the 
same time is absolutely necessary. 

‘To accomplish this the two ends of the ligature are fast- 
ened one each to a stick, one man pulling on it steadily; some 
time being required before the parts are firmly constricted. 

Traction ought to be exerted upon the cord steadily for 
one minnte to squeeze out all the liquid from the uterus wall 
and to cut off the circulation completely. 

Some suggested to circumcise the entire mucosa before 
applying the ligature, which would then include only the mus- 
cularis and serosa. This is not necessary, provided the liga- 
ture is tightened gradually and firmly, thus depriving the parts 
of any blood supply. 

The elastic ligature may also be used to advantage. The 
rubber tube is wrapped around the parts several times and 
fastened in the ordinary way. 

After ligating the uterus it is cut off 4 to 6 cm. from the 
ligature. Some practitioners wait twenty-four to thirty-eight 
hours before amputating it. This is only indicated when 


PROLAPSUS OF THE UTERUS 325 


danger exists that the ligature might slip off. When the liga- 
ture is applied properly, the uterus is severed and the stump 
replaced. 

The after-treatment consists in douching the vagina with 
warm antiseptic solutions. The ligature drops off in fifteen 
to twenty days. Should prolapsus of the stump appear, the 
vulva is sutured when necessary. 

Veterinarian de Vries at Zaltbommel (Holland) reports 
the following case. A cow which had calved normally retained 
the after-birth. Seven days later the owner, on entering the 
stable in the morning, found the uterus prolapsed and the 
decomposing secundines: adhering to it. The uterine mucosa 
was dark red and on some places almost black. In con- 
sequence of venous stasis, considerable infiltration of the sub- 
mucosa and muscularis had taken place, thus rendering the 
uterus enormously swollen. Reposition of the voluminous 
uterus was impossible, as there was danger of puncturing 
it with the hand, its powers of resistance being so little. De 
Vries therefore decided upon amputation. As a ligature a 
rope of pencil size was used. It was placed in the shape of a 
surgical loop around the folds of the cervix and tightened ; in 
order to make it slip better the loop was dressed with soap. 
The ends of the ligature were secured to two sticks, on 
which two men pulled vigorously. To satisfy himself that no 
intestines were included by the loop he incised the uterus and 
introduced the hand. By holding the finger on the spot to be 
constricted he appreciated the complete strangulation of the 
parts. After tieing the loop the uterus was severed 5 em. 
posterior to it. The stump was placed into the pelvic cavity 
and the animal walked about. The cow swayed to and fro, 
rotating the tail furiously. These symptoms disappeared within 
an hour, and the cow began to eat. Next day the temperature 
was 38.5 deg. C., the lacteal secretion had diminished, but 
increased on the following day. The vagina was syringed with 
a 1 per cent. pyoctanin solution. For six weeks the animal 
discharged a limited muco-purulent excretion. The animal 
was kept as a milch cow for 1} years and was ther fattened. 


326 BOVINE OBSTETRICS 


4.—Retention of the Afterbirth. Retentio 
Secundinarum. 


Causes.—The expulsion of the secundines at the normal 
time may be retarded by various causes. The etiology of this 
disease is of the greatest importance with regard to the various 
methods of treatment. Insufficient contraction of the uterus is 
probably the most common cause. While discussing the pro- 
cess of involution of the uterus the importance of uterine con- 
traction as regards expulsion of the foetal membranes was 
shown. The agglutination of the foetal and maternal placente 
represents, as we know, the union between the foetal membranes 
and cotyledons. When the uterus does not contract, the villi 
of the placentze maternz do not become quite bloodless ; there- 
fore they remain slightly enlarged, retaining as a result the 
villi of the placentz foetales. The union of course is not as 
intimate as at the time when the foetus existed in the uterus, 
since the foetal placenta were also filled with blood, The 
immediate function of the uterus is also wanting, in conse- 
quence of which the surface of the uterus becomes smaller and 
the mucosa plicated. This inactivity of the uterus often 
depends on excessive dilatation, as met with in multiple preg- 
nancy, hydrallantois and lardaceous calves. It may also 
follow exhaustion of the mother, as by long drives, or exhaus- 
tion of the uterus. The latter shows itself, for instance, when 
torsio uteri existed for several days before assistance was 
rendered. In such a case the secundine are mostly retained. 
In very fat cows the uterine contractions may be small after 
parturition, thus interfering with the expulsion of the after- 
birth. Here the fatty infiltration of the muscularis is probably 
the cause of the limited contractility. The retention of the 
afterbirth is often the result of firm adhesions between the 
foetal and maternal placenti (for instance, following a placen- 
titis). The placentitis usually terminates with the production 
of connective tissue. This new growth extends only to a few 
cotyledons and then mostly to a portion of it. The contrac- 


RETENTION OF THE AFTERBIRTH 327 


tions of the uterus are unable to sever the connective tissue 
adhesions of the placentz thus formed. Firm union of the 
placentz is also found in abortion at the seventh or eighth 
month of pregnancy. The union here is not always connective 
tissue; in fact, pathological changes in the placent fcetales 
prevent separation. 

A portion of the afterbirth may also be caught in the 
empty horn. This happens when the uterine contractions are 
very violent. A part of the membranes, especially a piece of 
the chorion, lies in the empty horn, where it has become united 
to the cotyledons. When the muscularis of the gravid horn 
contracts and the secundines are separated, their weight is 
sufficient to cause detachment of the foetal membranes in the 
empty horn. It may happen, when the uterine contractions 
are violent, that the slit-like opening leading into the unimpreg- 
nated horn becomes so narrow as to interfere with the expul- 
sion of the secundines lying within it. At the same time the 
balance of the afterbirth is also kept back. 

A closed cervix prevents expulsion of the foetal envelopes 
within the uterus. This is a frequent cause of retentio secun- 
dinarum. The membranes are separated but cannot be ex- 
pelled; it is often seen in cows with pendulous bellies. Here 
the process of involution is so slow that the cervical canal 
begins to close before the uterus has fully contracted. 

Symptoms.—The secundines may be partly separated and 
hang from the vulva; but it is possible that nothing is visible. 
Such animals mostly show but few symptoms, if any, during 
the first three days; nevertheless a disturbance may be notice- 
able previous to parturition (see “inversio uteri”). After three 
to five days that part of the secundines exposed to the air 
begins to decompose. This is not necessarily followed by a 
disturbed general health. It frequently happens that such 
cows are apparently healthy, only the lacteal secretion remains 
limited. 

Now and then straining is seen—that is, abdominal pres- 
sure supports the uterine contractions and attempts at micturi- 
tion. When a large amount of the secundines project from the 


328 BOVINE OBSTETRICS 


vulva, pressure is exerted upon the urethral opening, closing 
it more or less. In such a case the cow puts herself into such 
a position, with the back arched and the hind legs well under 
the body, that the opening is freed, rendering urination more 
easy. 

Vaginal discharge sets in usually after a few days. It is a 
muco-purulent, chocolate colored mass, consisting principally 
of mucus, uterine milk, remains of foetal waters and blood. 
The less the uterine contractions the greater the accumulation 
of this fluid in the uterine cavity. Some animals, when the 
secundines are retained for some time, show a pustulous exan- 
thema, especially on the udder and the inner face of the thighs. 
This exanthema occasionally follows normal parturition and 
abortion, disappearing generally in a few days. 


SEQUELS. 


1. The secundine adhere to the cotyledons and may be 
expelled in about six days, the uterus contracting after this time. 
The cow recovers after a muco-purulent liquid has been ex- 
pelled for quite some time. 

2. The secundinze decompose, usually after five or six 
days; the part hanging from the vulva having started to putrefy 
before this time. Decomposition also spreads toward the 
uterus. 

The presence of putrefactive bacteria in the secundines no 
longer in contact with vital parts, leads to the production of 
numerous toxines which may cause sapramia. 

{t often happens that the cow withstands the decomposi- 
tion of the afterbirth. Of course the general health is some- 
what disturbed, the cow dees not feed well, yields but little 
milk, but no further phenomena are observed. After some 
time the afterbirth mixed with pus is expelled piecemeal, so 
that one may speak of a maceration. 

3. Puerperal infection in the form of a septic or pysemic 
infection. This is especially so in emphysematous foetuses 
delivered by embryotomy ; possibly with injury to the genital 
canal. It is usually in these cases that the afterbirth is . 


RETENTION OF THE AFTERBIRTH 329 


retained on account of the excessive dilatation of the uterus 
and its insufficient contractility. 

4. Tetanus, which is very rare, may follow retention of the 
secundines (Giovanoli, Roder.) 

Prognosis.—It is pretty favorable, when proper assistance 
is rendered in time, but unfavorable when symptoms of puer- 
peral infection are already present before assistance is 
requested. 

Therapeutics —Treatment must be preceded by an internal 
examination. The point here is not so much what may we do 
in retentio secundinarum, but what are its causes and how may 
we remove them. 

The treatment depends on the causes, as they decide upon 
either a medicamentous or manual treatment. Some practi- 
tioners prefer the former, others the latter. Hither one may 
yield good results. It is best to first conduct a thorough 
examination, letting the treatment depend on the cause 
detected. 

It is not exactly an agreeable business to examine a cow 
with a decomposing afterbirth. The stench is often unbear- 
able and hardly to be removed from the arm. Nevertheless it 
must be done. When somewhat careful we need not soil our- 
selves particularly. Of course it is understood that no good 
clothing is worn for this work. Itis also a matter of course 
that any small wounds are well covered and that hands and 
arms are thoroughly oiled. Any negligence along this line 
exposes the operator to infection. 

The purpose of the exploration is to detect: Atony of 
the uterus, firm adhesions between the foetal and maternal 
placentz, whether caught in the empty horn (cornu) or closed 
cervical canal. Possibly a portion of the afterbirth passed 
through a perforating uterine wound into the abdominal cavity. 
All these are not difficult to recognize. When the uterus has 
not contracted sufficiently one feels during the examination 
only a few cotyledons close to the internal os uteri. The foetal 
placentz are readily removed from them; those cotyledons 
. further away are beyond reach of the hand. 


330 BOVINE OBSTETRICS 


While exploring, one may attempt to pull slightly on the 
secundines. For this purpose a part is seized with the whole 
hand and gentle traction exerted on them. In some cases this 
is successful; should it fail, it is indicated to induce uterine 
contractions. ‘This may be tried variously: in the first place, 
by subcutaneous injection of extractum secalis. I have 
frequently seen good results from an injection of 6 g. extractum 
secalis cornuti, dissolved in 8 g. glycerine and 12 to 20 g. of 
water. This mixture is injected below the skin in one dose. 
In about four to six hours uterine contractions set in and the 
secundines are expelled unless other causes retain ‘them. 
Contractions of the uterus may also be produced reflexly by 
friction of the abdominal parietes. 

For this purpose the abdominal walls on either side are 
dressed with stimulating agents (ammonia, ol. terebinth and 
spirit of camphor ana. 60), followed by friction with straw 
wisps. 

Irrigations with cold water are especially indicated to pro- 
duce uterine contractions. When all other means fail, it may 
be tried. 

When the cause of retention is a too firm union between 
the maternal and foetal placentz, the means just mentioned are 
of no avail, and separation must be practiced in some other 
way. Should the examination reveal the cotyledons to be 
within reach of the hand, they are to be separated with the fingers. 
Thisis doneasfollows: Hand and arm of the operator are closely 
examined (eventual small wounds covered with elastic collo- 
dium), and then oiled with creolin oil (1 creolin to 10 to 20 of 
oil). In between times an assistant washes the vulva, tail and 
thighs. While the tail is held to the right the operator passes 
the right hand into the vagina through the cervix into the 
uterus. The left hand grasps the secundines unless already 
hanging from the vulva. The right hand follows the secun- 
dines into the impregnated horn. After its condition has 
been ascertained he begins to separate the foetal placente lying 
close to the internal os uteri. For this purpose he places the 
cotyledons between thumb and index finger, stripping the foetal 


RETENTION OF THE AFTERBIRTH ook 


placenta from the cotyledons with the thumb. In this manner 
one goes from one cotyledon to the other, pushing the separated 
parts through the cervix and vagina into the left hand, so that 
they may be fixed without. Finally the foetal placente are 
stripped off the most distant cotyledons and the part of the 
chorion in the empty horn is also pulled out. Now the secun- 
dines are removed and the uterus syringed with an antiseptic 
solution; for instance, a one per cent. lysol or creolin solution. 
It is not always possible to remove the afterbirth in this way. 
When a new growth of connective tissue has followed a pre- 
ceding placentitis, the separation of the foetal placente is 
impossible on some places, and there is danger that bits of the 
footal membranes remain in situ. The latter is a dangerous 
thing, as it may lead to serious consequences. For this pur- 
pose a different line of treatment is indicated. 

It consists in twice daily irrigating the uterus with a 
warm antiseptic solution; for instance, a 2 per cent. acidum 
boricum, 1 or 2 per cent. alum solution, or 1 per cent lysol 
solution. This prevents decomposition of the secundines and 
assists in an aseptic maceration of the foetal placente, Both 
methods—that is, irrigation of the uterus and manual sep- 
aration—may be combined. While unbottoming the foetal 
placentz their separation is more readily effected by introduc- 
ing warm antiseptic solutions. 

This operation is most successful when performed on the 
third or fourth day. In some cases it is possible to remove 
the afterbirth on the day following parturition; in some cases 
all cotyledons are not accessible within the first two days after 
birth. On the third or fourth day the uterus has contracted 
sufficiently so that all parts can be reached. Therefore one 
waits for this period, unless its immediate removal is indicated 
on account of inversio uteri, injuries to the uterus, vagina or 
vulva, imflammation of the parturient passage and violent 
straining. 

In case a portion of the secundine is caught in the empty 
cornu, it is readily removed with the hand. On examination 
one feels the slit-like opening laterally in the wall of the once 


So2 BOVINE OBSTETRICS 


pregnant horn. When the cervix uteri is closed, an attempt 
is made to open it by a rotary movement of the fingers, event- 
ually passing the whole hand. This is usually successful with 
some persistence. It also happens that the secundines are 
detached and lie loosely in the uterus. They are removed by 
hand and the uterus flushed with warm antiseptic solutions. 

A great number of antiseptics are employed in irrigations 
of the uterus; for instance: acidum boricum, acidum ecarboli- 
cum, lysol, creolin, kalium permanganate, pyoctanin. The 
latter are less agreeable on account of their intensive color 
imparting itself to hands and arms. 

Bichloride of mercury should not be used in the cow for 
this purpose; also acidum carbolicum is questionable on 
account of its penetrating or transmitting itself to the milk. 
At the same time it may produce intoxications when used 
freely (Van Leeuwen). 

Many medicaments exist, employed with a view to expel 
the secundinz. But twenty years ago herba sabinex, kalium 
carbonicum, borax and flores chamomille were still used. 
They exert no action upon the uterus. Extractum hydrastis 
canadensis fluidum, recommended for this same purpose not 
so many years ago, also proved itself of no value (Albrecht). 


5.—Endometritis. 


By endometritis is understocd an inflammation of the 
mucosa and submucosa of the uterus. This disease is almost 
exclusively met with after parturition and during the process 
of involution. 


(a) ACUTE CATARRHAL ENDOMETRITIS. 


Aitiology.—Injuries of the mucosa during birth as they 
may occur while correcting a malposition. It is more readily 
produced when manipulation with instruments in the uterus 
takes place, which have not been cleansed previously, or when 
cords not previously softened are employed. As long as the 
foetal waters have not been entirely discharged the danger of 


ENDOMETRITIS 333 


injuries is less, as the uterus is closely moulded on the calf, the 
foetal waters acting as a protecting medium. A second cause is 
infection. Nothing definite is known with regard to the low 
organisms which cause endometritis. Its course only induces 
many to deal with this endometritis separately, and not 
include it in the group of “ puerperal infections.” 

Symptoms.—In some cows the afterbirth is expelled in 
time, though mostly after twenty-four hours or later. This 
retarded expulsion is the result of a slow process of involution. 

The general health is somewhat disturbed, appetite and 
rumination lessened; the cow strains occasionally; the tem- 
perature is usually normal; the quantity of milk has decreased. 
On internal examination on the third or fourth day after 
parturition, the cervix is still sufficiently opened: to allow the 
hand to vass into the uterus. 

The uterus is not contracted normally, but possesses a 
considerable lumen; the cotyledons have become smaller. 
Within the uterine cavity small pieces of the afterbirth are 
usually not met with, but a brown, slimy fluid, mostly inodor- 
ous. During the examination the cow strains, showing that she 
is suffering pain. . 

Course.—The course is usually favorable. After four to 
five days the uterus contracts, and from that moment the 
brownish fluid is discharged regularly. The appetite increases, 
rumination and lacteal secretion return, and the cow recovers. 
An examination after eight days reveals that the cervix is not 
entirely closed, but two or three fingers may be introduced, so 
that the lochiz can be evacuated properly. 

Therapeutics. —In such animals the contraction of the 
uterus is of primary importance. The resorbing surface thus 
becomes smaller and the danger of an infection less. Contrac- 
tions are induced by the subcutaneous injection of extractum 
secalis (5 g., the same amount of glycerine and water in one 
dose). Some veterinarians administer borax in pretty large 
quantities. 

According to my experience, I can also recommend borax 
in endometritis. Irrigations of the uterus in this disease are 





334 BOVINE OBSTETRICS 


not necessary. When practiced by the veterinarian himself 
they are of value. For that purpose a warm 2 per cent. 
boric acid or 1 per cent. alum solution is employed. By 
using it at body temperature violent straining is to a great 
extent prevented. 


(b) CHRONIC ENDOMETRITIS. 


Definition—A chronic inflammation of the mucosa and 
submucosa of the uterus, leading not only to considerable 
secretion, but also thickening of the uterine wall. 

AStiology.—Chronic endometritis may follow an acute one. 
Mostly it is due to certain agents in the uterine cavity acting as 
foreign bodies. As such may be considered: Remains of the 
afterbirth and retained not aseptic lochice. The latter often 
accumulates on account of closure of the cervical canal. 

Sequels.—As the result of the irritation of the uterine 
mucosa, a muco-purulent secretion follows, which mixes with 
the contents of the uterus so that a considerable accumulation 
of fluid may arise. This fluid varies; in one ease it is light- 
yellow and rather thin, then again resembles pus and mucus 
mixed, or ordinary pus; occasionally it is of a chocolate color. 
Depending on the type of the excretion, chronic endometritis 
has been termed variously to indicate the observed phenomena. 
Thus hydrometra, or dropsy of the uterus, is spoken of. The 
fluid is then mostly clear and watery, the quantity amounting 
to 10 to 20 1. or more. When the exudate within the uterus is 
purulent, one speaks of a pyometra. This trouble is often seen 
in the cow, usually being due to retention of the afterbirth. 
The amount of accumulated pus is frequently so great, that 
pregnancy is simulated. The mucosa of the uterus may undergo 
such changes that it resembles a granulating surface, these 
granulations protecting the organism against further infection. 

Symptoms and Course.—At first chronic endometritis is 
characterized by insignificant symptoms. A few days after 
birth the general health is slightly disturbed, but eight to ten 
days later the cow apparently recovers. The owner neverthe- 
less observes that the lacteal secretion is limited and that the 


ENDOMETRITIS 335 


animal remains emaciated while feeding well. After this state 
of affairs has lasted some weeks, he occasionally notices in the 
stable behind the cow a muco-purulent mass, which on closer 
examination comes out of the vulva. The discharge may be so 
plentiful that a large amount is found every morning. 

When the hand and arm are passed into the vagina the 
cervix is found apparently closed. The finger cannot enter and 
one possibly surmises the discharge of vaginal origin. This, 
of course, is incorrect. The fluid comes out of the uterus and 
is evacuated through the cervix by the uterine contractions, as 
the cervix easily opens by pressure from within outwards, but 
not in the opposite direction. On rectal examination the 
uterus filled with liquid often feels like an elastic ball. This 
disease, where quite an amount of pus or purulent mucus is 
discharged, is termed leucorrhea or fluor albus. Such a state 
may persist for months, the cow gradually becoming emaciated, 
depending on the intensity and extent of the disease. 

Prognosis.—This depends on the length of time the malady 
existed, as well as on any complications which may be present 
(see “ Polyarthritis”). When the discharge is only of a few 
weeks’ standing and the secretions become slimy, a favorable 
prognosis may be put; often recovery sets in without any treat- 
ment. An extensive pyometra, with subsequent marked emaci- 
ation, calls for an unfavorable prognosis. 

Therapeutics.—This endeavors to evacuate the uterus and 
to induce contractions by local treatment with antiseptic and 
astringent means. The uterus is best emptied by mechanical 
dilatation of the cervical canal. This requires lots of patience 
and repeated manipulations. To treat the uterus locally, a 
straight catheter is passed into the uterus through the cervix, 
attaching on its free end arubber tube and funnel. The uterine 
cavity is first flushed with warm water, followed by a 2 per 
cent. boric acid solution. After one or two days the uterus is 
irrigated with a 2 per cent. alum solution, to be repeated every 
other day. The injected fluid remains in the uterus for 10 to 
15 minutes, when it is evacuated by lowering the rubber tube, 
this acting like asyphon. In this way decided improvement is 


336 BOVINE OBSTETRICS 


obtained in about three weeks. Of course even this method 
occasionally fails in very old cases. 

When the cervical canal cannot be dilated from the vagina, 
and rectal examination proves the uterus excessively filled and 
distended, it may be punctured with a trocar through the abdo- 
minal parietes. It has frequently only a palliative effect—that 
is, the fluid can be evacuated but accumulates again—but cases 
are known where the animal improved greatly after tapping 
the uterus. The cow stands the operation well. 

Wester (Holland) reports a case he observed in a cow 
where the cervical canal could not be opened at all. Rectal 
examination revealed the uterus greatly distended by fluid. On 
puncturing the uterus he evacuated 90 1 of stinking pus. 
Through a rubber tube and funnel attached to the cannula, a 
creolin solution was introduced into the uterus. After the 
liquid thus introduced had flowed off through the cannula the 
trocar was withdrawn and the abdominal wall vigorously com- 
pressed. After the operation the cow did not develop any 
peritonitis. In the following month the animal gradually 
improved. After that fluid again accumulated in the uterus. 
The animal became emaciated, so that the owner finally decided 
upon slaughter. 


6.—Puerperal Infection. 
(a) SEPTIC INFECTION. 
1. Puerperal Phlegmon. 


Definition.—By it is understood a phlegmonous inflamma- 
tion of the vulva and vagina, arising during the puerperal state, 
characterized by extraordinary swelling. 

Af tiology.—Infection during parturition. Small wounds on 
the labize or in the vagina are to be looked upon as the sources 
of infection. Almost at each birth, with or without manual 
interference, injuries of a superficial or intensive nature occur. 

Bruises form especially favorable factors for infection. In 
the bruised tissues all around the wound the circulation is 
disturbed. 


PUERPERAL INFECTION 337 


Thrombi are formed, offering a favorable medium for 
pathogenic micro-organisms (streptococci, bacillus of malignant 
cedema). The infectious material is often furnished by decom- 
posing foetuses or foetal envelopes, but may also be introduced 
from without by manure, earth, dirty hands, ete. 

Granulating wounds are often observed in the vagina and 
on the labizw, while a decaying afterbirth is present at the same 
time. The granulating surface forms a protecting cover against 
many infectious substances. 

Symptoms.—The first three days following parturition 
usually pass without any symptoms, so that everything seems 
to take a natural course. On the 4th or 5th day swelling of the 
vulva sets in, confining itself at first to the labiz, on the follow- 
ing day extends over the anus, laterally forward over the pos- 
terior borders of the broad pelvic ligaments. The swelling 
may even extend to the flat of the thigh. The skin of the 
labize is glistening and tense, the mucous membrane yellowish 
red. A thin, yellowish fluid flows out of the vulva, dripping 
regularly from the lower commissure. The skin is tense as far 
as it is swollen; percussion gives a full sound. When the 
hand is passed over the swollen surface, crepitation is similar 
to symptomatic anthrax (black leg). The disease really resem- 
bles symptomatic anthrax very much, but when the swollen 
parts are incised subcutaneous and intermuscular accumulation 
of fetid gases is observed. The animal walks stiffly, appetite 
and rumination decrease. Defscation and micturition are 
mechanically suppressed on account of the oedema. The 
urine is discharged in small quantities under violent straining. 
The feces accumulate in the rectum, to be discharged now and 
then in the form of small, hard balls; occasionally it is of 
thin consistency. The temperature is 39 to 40 deg. C., the 
pulse at first normal, later accelerated. 

Vaginal examination, quite difficult on account of the 
swelling, reveals necrosis of the mucous membrane of the 
vagina here and there, so that the necrotic tissue adheres 
to the hand and arm. The cervix uteri is usually partly 
open. 


338 BOVINE OBSTETRICS 


Course and Prognosis.—Most cases terminate fatally. The 
swelling increases, and after a few days death sets in, often 
quite unexpectedly. 

Treatment in this disease is only slightly successful 
when the condition is still in its initial stage. When the swel- 
ling once extends over the sacrum and inner surface of the 
thighs, treatment is of little use. 

Care should be taken that air is given a chance to enter 
the tissues, as there is no greater enemy for the bacilli of 
malignant cedema than air. For this purpose deep, long 
incisions are made into the most prominent portion of the 
swelling in the direction of the posterior border of the broad 
pelvic ligament. 

Should the infiltration extend into the broad pelvic liga- 
ment and a communication exist with the vagina, a drainage- 
tube is introduced. The other side is treated in the same 
manner. Here one must not be knife-shy, but each canal must 
be searched for and split. The wounds are douched with a 2 
to 3 per cent. carbolie acid solution. 

Internally camphor and oleum terebinthina are given. The 
infection described as puerperal emphysematous anthrax has 
nothing common, according to Carl’s investigations, with 
symptomatic anthrax, but is simply a septicaemia puerperalis 
of unknown genesis, in which the bacillus of malignant cedema 
produces symptomatic anthrax-like phenomena. The cases of 
puerperal phlegmon observed by me strongly resemble the 
cases described in the literature as puerperal emphysematous 
anthrax. Some of the cases terminated fatally in one to three 
days, but on the whole the processes extended over more time. 
That the swelling ever involved the whole body, I never 
observed. 


2. Metritis Septica. 


Definition. —Metritis septica is an inflammation of the 
mucosa and submucosa of the uterus, due to infection, accom- 
panied by serious disturbances of the whole organisms, depend- 
ing on the presence of toxines in the circulatory system. 


PUERPERAL INFECTION 339 


Litiology.—The infection is usually produced by decompos- 
ing foetuses (emphysematous foetus) or secundines. It follows 
when low organisms enter through uterine wounds. 

It seems that the venous thrombi met with during the 
process of involution offer a favorable medium for germs ; from 
here poisonous agents may enter the circulation at any time, 
followed by serious symptoms of disease. 

Symptoms.—Septic metritis, as a rule, sets in three or four 
days after parturition. In most cases the afterbirth is still 
united to the uterus. This is almost invariably so after the 
birth of emphysematous calves. The general health is very 
good the first few days following birth. A disturbed general 
health is observed on the third or fourth day, appetite dimin- 
ishes, lacteal secretion decreases, the temperature rises (39.5— 
40.5 deg. C.), the pulse is often normal, at times slightly accele- 
rated. The animal occasionally strains and moans. The right 
abdominal wall is sensitive to pressure. 

The vulva, as a rule, is not swollen. On examination, the 
cervix is found open, so that the hand can be passed into the 
uterus. The parturient passage feels hot. In the uterus are 
found, besides remains of the afterbirth a fetid, chocolate 
colored liquid. Uterine involution is not far advanced. There 
is still a considerable lumen present. The mucosa is covered 
here and there with a croupous exudate. 

Pathological Anatomy.—The decomposing afterbirth or its 
remains are still connected here and there with the cotyledons. 
It happens occasionally a diphtheritic exudate is found upon 
the cotyledons and between them. The cotyledons, same as in 
normal involution, have decreased in size and undergone fatty 
degeneration. 

The uterine mucous membrane shows on many places 
hemorrhages in the shape of petechiz, but also large, diffuse, 
red spots, especially in the fundus uteri. The submucosa is 
thickened and cedematous. On section, a yellowish fluid is 
discharged. An exudate is also observed between the longi- 
tudinal and circular muscular layers. The serosa of the uterus 
shows punctiform hemorrhages. A gelatinous exudate is 


340 BOVINE OBSTETRICS 


noticed between the layers of the mesometrium and thrombi 
of rather firm consistency, in the arcus uterini. The lumbar 
elands are swollen. 

The other parts of the cadaver exhibit the symptoms of a 
septicaemia. : 

Course and Prognosis.—Many animals suffering with septic 
metritis die with septicemia; the rate of mortality is about 60 
per cent.; of the remaining 40 per cent. one half may be counted 
among the chronic cases, in which a chronic metritis followed 
after the processes came to a standstill; the course of the 
latter is doubtful. The prognosis is also unfavorable. In 
case of recovery, improvement sets in already in a few days. 
A too rapid recovery need not be expected, nor do the symp- 
toms indicate it, as experience teaches that death often sets in 
suddenly. 

Therapeutics:—It endeavors: 1, to destroy the low or- 
ganisms; 2, to increase the powers of resistance of the 
organism. 

For the former, artiseptic irrigations of the uterus are 
used, such as 1 per cent. solutions of lysol, creolin, carbolic 
acid. Some practitioners prefer a 2 per cent. alum solution, 
others a 1 per cent. pyoktanin solution. In this treatment 
the main thing is to first flush the uterus with warm water before 
the medicaments are introduced by means of the rubber tube 
and funnel, 

It is advisable to introduce 3 to 4 1. of the above named 
solutions each time, allowing it to flow out after ten minutes. 
To prevent any straining, the fluid must be of body tem- 
perature. The irrigations should be made once or twice daily. 
An important factor to limit the process is the contraction of 
the uterus. Should it be possible to produce uterine contrac- 
tions, the resorbing surface becomes smaller and the danger 
of a general infection diminishes. 

Internally such animals receive camphor with turpentine ; 
antifebrin may be employed. I have occasionally seen good 
results follow the administration of salol. 


PUERPERAL INFECTION 341 


3. Acute Puerperal Septiceemia. 


Definition.—A. septicemia of an acute type, following par- 
turition, its symtoms from the very outset predominating over 
any other. This septicaemia is of great importance from an 
obstetrical and hygienic point of view. The local disturbances 
in these cases are very limited, so that but few alterations of an 
insignificant nature are detected on post mortem and on 
microscopical examination of the uterus and vagina. Putre- 
faction is not necessarily present. This septicemia occa- 
sionally is met with after puerperal phlegmon and septic 
metritis. 

Aitiology.—Little is known of the infectious material caus- 
ing acute puerperal septiczemia in the cow. In all probability 
streptococci play a great role in this disease. 

Acute puerperal septiczemia occasionally follows difficult 
labor with injury to the parturient passage, and may be seen 
when birth takes place normally without manual interference. 

The source of entrance for the infection are wounds ; often 
these are only simple epithelial defects, as they occur in every 
normal birth. 

The infection may also take place by intermediaries; for 
instance, the arm and hand of the obstetrician, instruments, 
ropes, also straw and stable paraphernalia. 

I know cases of acute puerperal septicemia, where 
no exploration had been made, which died, and where the 
infection only could have been transmitted by straw which 
had been used as bedding for a cow dead with puerperal 
septicemia a few days previously. There are also eases known 
where cows died a few days after giving birth without any 
apparent cause, but slight assistance having been rendered 
them during parturition. Post mortem also failed to reveal 
any lesions which might throw light upon the cause of death. 
These mysterious cases only discontinued to appear after 
attention had been drawn to the transmission of the virulent 
agent, prevented after that by vigorous antiseptic measures. 

Symptoms,—The disease sets in suddenly on the second. 


342 BOVINE OBSTETRICS 


or third day after parturition. The symptom observed by 
the owner is the decrease in the lacteal secretion. Appetite 
has decreased or is wanting, rumination also. During the day 
other symptoms set in, as hurried respiration, and a more or 
less swaying gait behind. Cows standing in the stall often 
knuckle over in one hind leg. 

Examination shows a body-temperature of 41 to 41.5 deg. 
C. The pulse is frequent, the eye dull; the animal strains 
occasionally and gives vent to a low moan. The conjunctiva 
is injected and slightly yellowish; the same refers to the 
mucosa of the labiz. The vulva is swollen but little, if any. 

In case epithelial defects were on the mucous membrane 
of the vulva or vagina, infection taking place through them, 
they now have changed into a puerperal ulcer. They are 
differentiated from ordinary ones by the fact that a diffuse 
redness is observed in their neighborhood. Close inspection 
is necessary to detect them upon the yellowish mucosa. 
Exploration usually reveals an open cervix. When the examina- 
tion takes place on the third day after birth, two or three 
fingers, sometimes the whole hand, can be passed into the 
cervical canal. In the uterus fetid lochiz and remains of the 
afterbirth are sometimes found. Nevertheless, in those cases 
where parturition took a normal course and the fetal envelopes 
were expelled in time, the uterus only contains a small amount 
of an inordorous brownish liquid. 

Course and Prognosis.—Acute puerperal septicemia is a 
disease where a fatal termination is the rule and recovery a 
great exception. As soon as the first symptoms appear death 
follows often unexpectedly within one to three days. 

Pathological Anatomy.—Such a cow when killed does not 
reveal satisfactory lesions on post mortem examination. 
Ostertag, therefore, correctly says that just the absence of 
serious lesions of the internal organs, respectively the insignifi- 
cance of the changes, apparently out of proportion to the 
serious disturbances, observed intra vitum, should induce us 
to suspect sepsis. 

In animals which succumbed to the disease the changes 


PUERPERAL INFECTION 343 


are more marked. Already when the skin is removed the 
cedema shows the symptoms of septiceemia. The blood is fluid 
and not coagulated. The muscles appear as if boiled. The 
uterine mucosa sometimes shows the lesions of a septic me- 
tritis, but in many cases nothing but a slight infiltration of the 
submucosa, which may also be wanting, is noticed. The serosa 
of the uterus shows hemorrhage here and there. A glutinous 
exudate is occasionally observed between the layers of the 
mesometrium, the same possibly seen under the serosa of the 
uterus. The process of involution did not run a normal course, 
the uterus is not contracted as it should be in a normal state 
at this time. In the uterine cavity is found a limited amount 
of a chocolate colored fluid. 

The peritoneum shows ecchymoses here and there. In 
some cases enteritis is met with. The liver shows parenchy- 
matous degeneration, a symptom, at the same time less intense, 
observed in parturient paresis. 

The spleen is soft and somewhat enlarged. The kidneys 
show fatty degeneration. 

Petechiz are found here and there upon the pleura, ende 
and epicardium. The lungs, leaving out hypostasis, are normal. 

Occasionally cases of hemorrhagic pleuritis are observed. 

Therapeutics.—When acute puerperal septicemia is once 
diagnosed in a cow, treatment is of little use. 

Antiseptic irrigations of the uterus may be tried and those 
agents used already mentioned under septic metritis. 

It is advisable in these cases to give camphor dissolved in 
ether subcutaneously ; also oleum terebinthina per os may be 
used, as well as alcohol. Many veterinarians give salicylate 
of soda, others antifebrin and borax. 

Prophylaxis is of vital importance. Care should be exer- 
cised to prevent transmission of the infection from one cow to 
another one. For this purpose the following must be observed : 

Arms and hands must be mechanically cleansed after 
rendering assistance during parturition or exploring for a 
retained afterbirth. This must first be washed with soap and 
warm water, next disinfected with a 2 per cent. creolin solution ; 


344 BOVINE OBSTETRICS 


the finger nails must be cut short and any dirt under them 
removed. 

Ropes used to deliver emphysematous calves or in cows 
succumbed to septicemia should be destroyed. Wooden 
instruments are to be boiled, iron ones disinfected by flaming 
them. The greatest care must be bestowed upon the disinfec- 
tion of the hands when any animals have been examined pre- 
viously suffering with erysipelas or phlegmon, or when a post- 
mortem examination had been conducted. 

When a case of septic infection occurs in astable, all other 
pregnant animals should be removed to another stable to calve. 
The stall occupied by the patient is to be thoroughly dis- 
infected. 

I saw that a cow died with puerperal septiczeemia due to 
retentio secundinarum. Fourteen days later a second cow died 
with the same disease (after the prolapsed uterus was readily 
returned). Although I told the owner to disinfect the stable 
and remove the remaining pregnant cows after the death of the 
first one, he paid no attention to my advice, and in about eight 
days a third cow died with puerperal septicemia. In this cow 
birth was normal and the afterbirth was expelled in time. 
Since no cows calved after this last case, and they were put on 
pasture, the infection disappeared. In the following winter no 
puerperal septicemia showed itself in this stable, although the 
owner did not disinfect the premises properly during the 
summer. Air and sunlight no doubt disinfected the stable. 


(b) PYAMIC INFECTION. 


Polyarthritis, metastatic synovitis and chrome parametritis 
belong to this group. 


1. Polyarthritis, 


Definition.—Polyarthritis, which follows parturition, is an 
inflammation usually of several articulations, especially the 
tarsus and carpus, depending on infectious material from the 
uterus. 

The disease may start from the synovial membrane or the 


PUERPERAL INFECTION 345 


marrow tissue. In either case arthritis may be serous or 
purulent. 

Aitiology.—The source of the infection is the uterus. The 
circulation carries the low organism as emboli through the 
veins to the right heart, then through the pulmonary circula- 
tion and systemic circulation into the capillaries of the bone 
marrow. That osteomyelitis may follow intravenous infections 
of the micrococci, without traumatism otherwise, Rodet’s and 
Lexer’s experiments show. 

The infectious agents, same as in polyarthritis, due to in- 

fection of the navel, are carried by bits of thrombi into the 
~ eireulation, where they float along until they are arrested in 
parts where the current is slow and the passage too narrow, 
now exerting their evil influence (Vogel). 

During the first few days following parturition the uterus 
is an excellent medium for the development of low organisms; 
especially when parts of the placente have remained and 
decompose. How far these low organisms or their poisonous 
products are concerned in the production of polyarthritis is not 
yet decided. Vogel is of the opinion that those parts devoid of 
epithelium are the real source through which infection takes 
place. He also remarks that he was struck by the fact that he 
usually received a positive reply to the question whether a 
hemorrhage occurred at the time the foetal envelopes were ex- 
pelled or whether bloody streaks were observed in the dis- 
charge. He therefore believes that most cases of puerperal 
arthritis depend on slight wounds. Strebel thinks that this 
arthritis is due to the resorption from the uterine cavity of 
putrid, septic, poisonous materials formed after parturition. 

Polyarthritis is often seen in cows where the expulsion of 
the afterbirth is retarded, but also in cows apparently under- 
going a normal process of involution. Another disease due to 
the same cause, often observed with puerperal arthritis, is 
mastitis of one half or quarter of the udder. Polyarthritis 
may also be asymptom of pyzmia. 

Symptoms.—A few days after birth, usually on the sixth or 
eighth day, the cow walks stiffly. When in the stable the 


346 BOVINE OBSTETRICS 


owner observes that she rises only with difficulty. She seems 
to suffer a great deal of pain and lies down most of the time. 
The appetite, rumination and lacteal secretion have diminished. 
The temperature rises to 40-40.5 deg. C. On examination, the 
afterbirth is often found in the uterus, but sometimes it is 
already expelled. In the latter instance quite a quantity of 
chocolate colored secretions is discovered in the uterus, by no 
means always fetid; in fact, inodorous in many cases. 

The painful joint is often recognized by the swelling. 
The hock is swollen at the epiphysis of the tibia. Palpation 
causes the animal decided pain. The capsular ligament is 
often tense, due to an over amount of synovia, especially 
noticeable on the anterior and internal aspect of the articula- 
tion. 

When standing up the cow elevates the diseased leg, 
momentarilly touches the ground with the toe of the claw, 
followed by immediate flexion, acting as if it causes her pain 
to rest the foot upon the floor. This symptom, characteristic in 
itself, is almost always present. In many cases the carpus is 
also diseased, either because the epiphysis of the radius is 
swollen and very painful, or on account of the distension of 
the upper capsular ligament. 

When both joints are diseased, walking is very painful, 
and when the cow lies down, it is difficult to induce her to 
rise. The femoro-tibial articulation may also be involved: 
although it is rare to see it primarily diseased, it usually 
follows when the tarsus and carpus have been already attacked. 
In case the epiphyses are also involved emaciation sets in 
rapidly. Vogel states that in such cases turbid urine is 
passed, and that dyspnoea, cedema of the brisket and in front 
of the udder is met with, depending on internal metastasis 
(lungs, liver, kidneys). 

Course and Prognosis.— When the disease is confined to a 
synovitis serosa the course is usually favorable, and complete 
recovery may follow in a few weeks even when the tarsus and 
carpus are implicated. Osteomyelitis, on the other hand, may 
be of an acute type, terminating fatally in four to six days, 


PUERPERAL INFECTION 347 


but may take a subacute course accompanied with consider- 
able changes in the joints, the animal dwindling down to a 
skeleton. In purulent arthritis, with periarticular abscesses 
or diffuse phlegmon in the neighborhood of the joint, prog- 
nosis is unfavorable. 

Pathological Anatomy.—The vessels of the synovial mem- 
brane are injected, in more chronic cases thickened, and its 
surface rough. The synovia is of orange color, occasionally 
purulent. The tissues on the outside of the synovial mem- 
brane show a gelatinous infiltration, showing little purulent 
foci, which do not communicate with the joint. 

The cartilage of the bony extremities is destroyed in 
the more chronic cases. In cases of osteomyelitis suppura- 
tiva, parts of the epiphysis are thrown off; the liquefied mass 
may perforate the bone at any place, giving rise to fistulous 
tracts (Vogel). On post mortem, multiple pus foci in the lungs 
and endocarditis are now and then observed. 

Therapeutics.—When the secundine are not yet expelled, 
they must be removed and the uterus irrigated with a 1 per cent. 
lysol or creolin solution. Even when the afterbirth has been 
discharged and the os uteri still sufficiently dilated to pass the 
hand into the uterus, this irrigation must be practiced. The 
solution is best employed cold, to produce uterine contrac- 
tions, thus decreasing its resorbing surface. 

The diseased joints are shaved, the skin soap-washed and 
scrubbed. Now Priessnitz fomentations of a 5 per cent. car- 
bolic acid solution are made. This treatment, proposed by 
Vogel, has given excellent results in many cases. The joint is 
first covered with jute saturated in 5 per cent. carbolic acid 
water; over it is placed wet parchment paper, and ‘over the 
whole an ordinary bandage. This dressing is renewed once 
daily. After five or six days vesicants or massage may be used. 

Strebel orders the joint rubbed and massaged lightly three 
times daily with a weak volatile liniment. Munch saw good 
results from a 10 per cent. ichthyol-camphor salve. In the 
suppurative form Vogel recommends puncture with Paquelin’s 
thermocautery, passing the red hot point directly into the bone. 


348 BOVINE OBSTETRICS 


Internally such animals may receive antiseptics, such as 
camphor with oleum terebinthina salve and salicylate of soda. 
In purulent arthritis the principles of surgery come into 
play. 
2. Metastatic Synovitis. 


In most cases the sheaths of the flexor tendons on two or 
more legs are involved. 

Symptoms.—The animal shows a stiff and painful walk. 
They lie a great deal, appetite has decreased, and the lacteal 
secretion is considerably less. Local examination reveals that 
the tendon sheaths are swollen, warm and painful. Metastatic 
synovitis may accompany polyarthritis or exist per se. 

The prognosis is quite favorable when only one or two legs 
are diseased. Should all legs be involved, the danger of 
decubitus, especially in old, emaciated cows, is present. Prog- 
nosis in those eases is doubtful. In the latter instance a 
great deal may be done by timely interference. 

Therapeuties.—When the os uteri is still open, antiseptic 
irrigations of the uterus are indicated; internally antiseptics 
are to be administered. The diseased sheaths are treated with 
Priessnitz fomentations. In cases of a chronic nature, massage 
with iodine ointment is indicated. In purulent inflammations 
the sheath must be opened, an incision being preferable to 
puncturing it with the trocar; that this is to be followed by an 
antiseptic dressing is necessarily a matter of course. 


3. Chronic Parametritis. 


Astiology.—Chronic parametritis is a chronic inflammation 
of the annexes of the uterus, which depend probably on a 
pyemic infection from the uterus and in which the process 
localizes itself at first in the wall of the uterus and the 
mesometrium. 

Pathological Anatomy.—The lymph vessels of the submucosa 
receive the infectious material, carrying it through the balance 
of the uterine wall and through the annexes as far as the 
lumbar glands, where further spread is often stopped. 


PUERPERAL INFECTION 349 


Parametritis is often accompanied by considerable exuda- 
tion into the muscularis and submucosa of the uterus. The 
inflammation also attacks the serosa of the uterus (perimetritis), 
so that even adhesions with the neighboring organs may take 
place. 

The wall of the uterus thickens two to five times. Later 
multiple abcesses of pea to walnut size or single large abcesses 
form in the wall and possibly in the tissues of the pelvis. 

Symptoms.—In the first few days after parturition the 
symptoms of an acute puerperal infection are manifested, 
usually due to a retained afterbirth. At that time the diagno- 
sis is septic metritis. A few days after the afterbirth has been 
expelled or removed by hand, improvement apparently sets in. 
The owner nevertheless observes that the cow is not well, 
feeds poorly, ruminates slowly and that the lacteal secretion 
is limited. On examination the following phenomena are 
noticed: temperature 39 to 40 deg. C., pulse normal, respira- 
tion slightly accelerated. Defsecation is normal or thinner 
than usual. When such an animal is taken out of the stall, 
dragging of the hind legs so that the toes trip is conspicuous. 
Occasionally one hind leg is seen to knuckle over. Lameness 
or pain about a joint is not seen in the beginning. The latter 
are occasionally observed later in consequence of pyzmic 
metastasis. On exploration per vaginam the cervix is found 
closed, or when the examination is conducted in the first week 
after parturition, two fingers may be possibly passed. A few 
rotatory movements of the hand suffice to enter the uterus. 
The uterus is not contracted, its lumen is still quite large. As 
aresult of this the lochia have accumulated and a brown, 
muco-purulent liquid is found in the uterus. Rectal examina- 
tion also confirms the dilated state of the uterus. 

The course is that of a chronic disease, followed occasion- 
ally by recovery, while at the same time chronic pyzmia is the 
more common termination. 

Prognosis is unfavorable. 

Therapeutics.—When the cervix is still open, antiseptic 
uterine irrigation must be made. To produce contraction of 


350 BOVINE OBSTETRICS 


the uterus a subcutaneous injection of extractum secalis (6 g.) 
is indicated. The internal administration of camphor with oil 
of turpentine also gives good results. In cases of long stand- 
ing potassium iodide may be tried. 

When abscesses form in the excavatio recto-vaginalis, 
occasionally the case, they are to be punctured with a trocar 
through the upper vaginal wall. To evacuate the pus, the hand 
passed into the rectum presses upon the abscess. 


7.—Puerperal Intoxication. 


(a) INTOXICATION DUE TO RETAINED LOCHIA. 


When the process of involution of the uterus is retarded, 
lochiw accumulate in the uterine cavity. The latter may be 
aseptic, but obtain properties by chemical changes of great 
moment to the organism. 

Ai tiology.—Following the birth of twins, where the expul- 
sion of the afterbirth was normal, as well as in fat cows, a 
retarded involution of the uterus with an aseptic uterine 
secretion is occasionally observed. In these cows the 
contractility of the uterus has been diminished by fatty 
infiltration. 

Parturition was absolutely normal, so that no exploration 
occurred. The lochie, consisting mainly of uterine milk, blood 
and mucus, constitute an albuminous fluid, from which toxie 
agents may be formed by chemical changes, which are absorbed 
by the uterine mucous membrane and may give rise to symp- 
toms of disease. 

Symptoms.—Two or three days after normal birth the 
owner observes that the cow is dull, appetite is a little less, 
rumination is irregular, lacteal secretion gradually decreases. 
This state often persists several days before veterinary aid is 
requested, because the symptoms do not worry the owner. 
Besides these symptoms he notices slow defecation and hard 
feeces, absence of lochial excretions. Temperature, pulse and 
respiration are normal. 


PUERPERAL INTOXICATION 351 


The course is almost always favorable. Gradual improve- 
ment takes place in about eight days, even without treatment, 
without liberal excretion of the lochiw. The lochiw are partly 
resorbed. All this time the cow is slightly soporous; paretic 
phenomena are not observed. 

Therapeutics.—It endeavors to induce contraction of the 
uterus and thus remove the cause of the intoxication. For 
this purpose ergot of rye is injected subcutaneously. In many 
cases the cervix is still sufficiently open that two fingers can be 
introduced. Nevertheless it is not advisable to practice its 
mechanical dilatation with subsequent irrigation of the uterus, 
as thus low organisms may reach the uterus, complicating 
matters. 

I have frequently seen good results in such animals when 
given daily 3 gr. liquor ferri sesquichlorati in } |. of water per os. 


(6) PUTRID PUERPERAL INTOXICATION, SAPRAEMIA. 


Definition —A putrid puerperal intoxication is an intoxi- 
cation during the puerperal state (puerperium), due to poison- 
ous agents coming from bacteria of putrefaction. 

tiology.—Putrid intoxication results when the retained 
afterbirth decomposes. Toxines form in consequence of it in 
the uterus through the influence of putrefactive bacteria. The 
poisons taken up into the circulation produce violent toxic 
symptoms. This intoxication must not be confounded with 
septic metritis. In this disease not the slightest injury of the 
uterine mucosa need be present. 

The healthy mucous membrane may take up the toxins. 
This disease frequently follows retention of the afterbirth. 
Intoxication of a slight degree is very common. The organ- 
isms at the same time have sufficient power to overcome them 
and to resist until the foetal envelopes are expelled. When 
many toxines have been produced this intoxication may be 
rapidly fatal. 

Symptoms.—When the afterbirth is decomposing, appreci- 
ated by the stench, the animal begins to be dull and listless 


352 BUVINE OBSTETRICS 


about the fifth day. Appetite and rumination and the lacteal 
secretion have decreased ; temperature is normal. Defzecation is 
usually a little slow ; in that case diarrhoea follows later. The 
animal urinates frequently and in small quantities. 

This state may last three to four days. When at that 
time the afterbirth is expelled or proper assistance given, 
the cause of the disease disappears and the animal regains 
its health. 

But when the decomposing mass is retained, new toxines 
forming constantly, the amount of poison in the circulation 
may become so great that the picture of the disease changes 
suddenly and symptoms indicating a serious condition manifest 
themselves. The animal appears as if paralyzed, sways behind 
and occasionally remains in the recumbent position. A state 
of sopor sets in, appetite and rumination being suspended. 
The cow lies with the head to one side, producing expiratory 
moaning. This condition may last one day or only a few hours, 
death taking place quickly. 

Prognosis.—In the beginning such animals can be saved. 
Whenever sapremia is well established, prognosis must be 
unfavorable. 

Therapeutics. —There are two indications: 1, produce 
evacuation of the uterus; 2, to induce contraction of the 
uterus. 

The afterbirth is removed with the hand and the uterus 
thoroughly flushed. This treatment is not always easy. Some- 
times it is necessary to dilate the cervix a little to pass the 
hand into the uterus. 

The afterbirth often resembles detritus, lying in a choco- 
late colored fetid liquid. 

After flushing with warm water the uterus may be irrigated 
with a 1 per cent. lysol or creolin solution. This treatment 
often is followed by immediate success. When sopor is present, 
spirits of camphor or camphor dissolved in ether, subeutane- 
ously injected, may be indicated. 

When pharyngeal paralysis is excluded an infusion of 
coffee with ether may be recommended. 


PARTURIENT PARESIS 


353 


_————— 





SEPTIC METRITIS. 





COMPARATIVE REVIEW. 





ACUTE PUERPERAL 
SEPTICEMIA. 


PUTRID PUERPERAL 
INTOXICATION, 





1. Sets in on third or|Sets in two or three 


fourth day after birth. 


days after birth with 
symptoms of serious 
illness. 


2. Temperature 39.5 to| Temperature up to 41.5° 
C. C. 


40.5° 


3. Pulse 
slightly accelerated. 


normal or|Pulse and _ respiration 


frequent. Mucous 
membrane injected, 
slightly icteric. 


4. The uterus contains a} The uterus occasionally 


fetid chocolate colored 
liquid with remains of 
afterbirth. 


5. In 20 per cent. of the 
cases recovery may 
take place. The dis- 
ease may also termin- 
ate fatally in four or 
five days or take a 
subacute course. 


contains a portion. of 
the afterbirth. Puer- 
peral ulcers are found 
upon the mucous mem- 
brane of the vagina 
and vulva. Putrefac- 
tion need not be pres- 
ent. 


The course is fatal in 
almost all cases with- 
in one to three days. 





Sets in on fourth or fifth 
day after birth and 
even later. 


Temperature normal. 


Pulse normal. 


The uterus contains pie- 
ces of the afterbirth 
lying in a fetid brown 
fluid. 


Early treatment may be 
followed by recovery 
Where sapremia is 
well established (seri- 
ous illness with symp- 
toms of paralysis) the 
course is usually un- 
favorable. 


8.—Parturient Paresis. 


By parturient paresis, a name »riginated by Schmidt- 


Miilheim, is understood a disease of the central nervous system, 
occurring in the cow during the first few days after parturition, 
rarely before or during birth. It is a disease characterized by 
an acute course, attacking mostly cows five to eight years old, 
and which have been fed well and are heavy milkers. 
History.—J. G. Eberhard described this disease already 
in 1793 under the name of “ Moerzickte.” He gives a detailed 


_———— 
.RyY SSN 


354 BOVINE OBSTETRICS 


description of it in his treatise, “ Verhandeling over het ver- 
lossen der Koeien”’ (treatise on bovine obstetrics); but his 
remarks show that he dealt both with parturient paresis and 
puerperal septiceemia. Jérg (1818) terms the disease milk 
fever. Mitchell gives a close description of it 1820. Binz 
(1830) designates it as sporadic typhoid milk fever. Rychner 
ealls it adynamia nervosa generalis, Rainard fievre vitulaire. 
Franck described the disease in 1876 as eclampsia puerperalis. 
He was the first one to separate parturient paresis from septi- 
cremia puerperalis, thus putting an end to the confusion exist- 
ing with regard to the two diseases. 

Friedberger and Frohner later differentiated between par- 
turient paresis, septicemia puerperalis and a mixed form, 
which offered clinically the symptoms of a parturient paresis 
but from an anatomo-pathological point of view the picture of 
a septic inflammation of the uterine mucosa. The existence of 
the latter form is undeniable, although rare. Among many 
diseased animals slaughtered I observed several times that the 
diagnosis “parturient paresis” was called for intra vitam, 
while the autopsy offered the picture of a septiczemia. 

LBtiology.—There is no other disease the wtiology of which 
exhibits greater differences of opinion than this one; conse- 
quently a number of hypotheses exist, trying to explain it. 

1. The hypothesis, according to which parturient paresis 
is due to circulatory disturbances after parturition. 

Franck supposes that contraction of the uterus is followed 
by an increased pressure in the aorta in case the flow of blood 
to the udder and skin is interfered with. When these channels 
of the blood, which flows during pregnancy to the uterus, no 
longer are able to take up the increased amount, back pressure 
arises and with it an increase of pressure in the aorta. The 
latter produces cerebral congestion and cedema with subse- 
quent cerebral anemia. This process, according to Franck, is 
supported by: 1, cardiac hypertrophy; 2, plethora; 3, 
hydremia. 

Franck’s theory has found many supporters, although 
some phenomena, such as the occurrence of parturient pro- 


PARTURIENT PARESIS 355 


cesses before dilatation of the cervix and a sudden recovery, 
cannot be explained by it, nor is cerebral cedema always present 
on autopsy. 

2. Harms’s theory. According to Harms, the symptoms of 
parturient paresis are due to air bubbles in the blood (aerzemia). 
He supposes that the air enters through the veins of the uterus. 

3. The theory of autointoxication. According to a gene- 
rally accepted opinion, parturient paresis depends on poisons 
generated within the body and which have entered the circula- 
tion. The intoxication therefore looked upon as an autointox- 
ication is said to be due to poisons (toxins) coming from the 
lochiz, milk and intestinal canal. 

Schmidt-Milheim supposes that a material is developed 
out of the lochiaw by certain processes of decomposition quite 
different from putrefaction, which are analogous to sausage 
poison, when taken up by the blood produces serious symptoms 
of disease. 

Freidberger and Fréhner adopted this theory and believe 
that the symptoms of parturient paresis, as well as the occa- 
sional cases previous to parturition—that is, about the time 
the cervix dilates—may be explained by it. In fact, the symp- 
toms of parturient paresis (muscular paresis) oo those of 
botulismus greatly. 

Thomassen (Holland) thinks that the toxins are formed in 
the milk. Already in 1889 he wrote (Rec. de méd. vét.) that a 
correct theory as regards parturient paresis should explain : 

1. Why this disease is peculiar to the bovine species. 

2. Why it occurs especially at a certain age—that is, after 
the birth of the third calf. 

3. Why exclusively in well fed animals (heavy milkers) 
which calved easily. 

4, Why the disease occurs occasionally before birth and 
after parturition within 48 hours. 

5. Why the disease develops so rapidly, disappears quickly 
without reconvalescence. 

None of the known hypotheses fill these demands. The 
fifth question might be explained by the more and more 


356 BOVINE OBSTETRICS 


accepted view that the disease is due to intoxication—that is, 
autointoxication, in which the dose is fatal or not. In the 
latter instance nature soon gains the upper hand. But where 
does the poison originate? For at least ten years Thomassen 
supposes and thinks that it should be looked for in the milk, 
where toxins are formed from the albumen by the influence of 
low organisms. The amount of albumen in the colostrum is 15 
to 20 per cent. (besides some sugar), soon drops to 2 per cent. 
and even less. This explains why the disease occurs occasion- 
ally before birth and mostly at atime when the third to seventh 
calf is born, at which time lacteal secretion is at its best. 

In poorly nourished or sick animals (also in those which 
had difficult labor) the production of milk and albumen is less 
than normal. 

In no animal is the milk after its secretion retained as 
long in the udder as in the cow, thus affording opportunity for 
the development of toxalbumens. In other animals the young 
empties the udder each time it sucks. 

Are low organisms present in the udder? 

Thomassen, already in 1893 and 1894, examined the fluid 
of the udder some time before parturition and always found 
diplo and steptococci. In fact, there is no animal in which 
low organisms find as readily entrance through the ducts 
of the teats as in the cow; in this animal infectious mastitis is 
also commonly observed. 

Thomassen in 1893 experimented with the milk of cows 
suffering with parturient paresis, by injecting it into calves. 
He injected as much as 100 g. subcutaneously, but without any 
results. A point in favor of this hypothesis lies in the fact 
that milking previous to parturition as a prophylactic measure 
frequently gives good results, that the disease is almost 
unknown in loealities where the calves suckle, that it is less 
common on pasture, where the danger of an infection is 
decreased, than in the stable. Nevertheless, the above named 
bacteria should not be held responsible, as others may enter 
just as readily. This explains also why several successive 
cases appear in one and the same stable. 


PARTURIENT PARESIS 357 


Albrecht and Ostertag suppose that the symptoms of 
intoxication are due to leucomaines. 

Eber looks upon parturient paresis as a toxigen disease. 
The toxigen also forms in the parturient passages of a parent 
which remains healthy, the toxigen being excreted as such. 
As a result of metabolism it is supposed to be changed into a 
real poison in the diseased ones. 

Kaiser believes that the poisonous agent forms in the 
intestinal tract, being primarily a nerve poison and secondarily 
a muscle poison. 

Ehrhardt also believes in the theory of autointoxication. 
According to him, parturient paresis is a chronic autointoxica- 
tion, developing acute clinical symptoms as a result of parturi- 
tion. 

It depends on: 1. An increased accumulation of poisons, 
products of metabolism in the latter stage of pregnancy. 2. 
On a decreased elimination during the period colostrum is 
secreted. The fact that the parent becomes seriously ill in 
consequence of the intoxication, and the calf is born alive in 
cases where the disease shows itself before or during parturi- 
tion, Ehrhardt explains by the antitoxic action of the thymus 
gland, which paralyses the effects of the ptomaines in the 
foetus. 

4, Intoxications due to products of metabolism of low organ- 
isms. Guillebeau and Hess found, in eight autopsies on cows. 
dead with paresis, four times a serous phlegmon of the uterus, 
twice lacerations of the cervix uteri, twice necrosis of the 
muscles behind the bony pelvis. In all these cases the puer- 
peral state took a normal course, so that injuries of the 
parturient passages seemed excluded. According to Guille- 
beau and Hess, a close relationship exists between labor pains 
and serous phlegmon of the uterus and over-distention and 
bruising of the mucous membrane of this organ by hard parts 
of the feetus. Such a bruised spot would afford a proper 
medium for the accumulation of bacteria. They believe that 
the infection is caused by micro-organisms quite common to: 
the vaginal mucous membrane, as the bacillus cedematis. 


358 BOVINE OBSTETRICS 


maligni, the bacillus bovis morbi ficans (Forster), and others. 
According to these authors, they may also emigrate from the 
intestines. 

Nocard examined many uteri of cows dead with parturient 
paresis and studied bacteria of the uterine secretions. He 
a'ways found staphylococci, and thinks that these microbes 
play an important réle in the pathogenesis of parturient 
paresis. He thinks that the symptoms are due to the toxins 
formed by those low organisms. He refers further to 
Nicolaier’s bacilli, which do not cause severe disturbances on 
the spot occupied by them while the action of their toxins 
nevertheless is exceedingly virulent. 

History —Parturient paresis almost exclusivsly occurs in 
cows which have calved three or more times. Most of them 
have had the fourth or fifth calf. This disease, although less 
frequent, is also observed in old cows. 

By far the most of the patients are in good flesh ; fat cows 
even seen predisposed to the disease. Hmaciated animals, 
when heavy milkers, may also suffer with this disease after 
parturition. Asa rule, easy normal birth precedes. When the 
disease sets in before or during parturition the pains are feeble 
and often insufficient to expel the foetus, so that they must be 
assisted by traction on the young. 

Many observers have noticed that the disease is more 
frequent in some families than others. Its heredity is not yet 
established, although some observations point in that direction. 

Most cases of parturient paresis occur twelve to forty- 
eight hours after parturition. This disease occasionally mani- 
fests itself previous to parturition (Albrecht, Andersen, Mattel, 
Meltzer, Monsarrat, de Bruin). My statistics, published 
already in 1887, mentions among the seventy-four cases of 
parturient paresis, one case eight days before birth, two cases 
three days before and three cases during parturition; seven 
cases one to six hours, twenty-two cases six to twelve hours, 
six cases twelve to eighteen hours, twenty-two cases eighteen 
to twenty-four hours, and eleven cases twenty-four to twenty- 
eight hours after parturition. 


PARTURIENT PARESIS 359 


Tt has been frequently observed that a cow which recoy- 
ered from parturient paresis was predisposed to it at the suc- 
ceeding birth. Of the seventy-four above mentioned cows six 
had the disease the year previous, some which calved later 
several times escaped the disease. Gassner mentions a cow 
which had parturient paresis three times in succession. I also 
observed. such a case. 

Tn localities where the animals are heavily fed and great 
milkers the disease is more common than in parts where food 
and lacteal secretions are limited. 

Symptoms.—In case the disease sets in during parturition, 
the feeble pains first attract the attention of the owner. The 
presentation of the calf is usually normal, so that but little 
force is required to finish birth. 

In most cases parturition is easy and takes a normal 
course, and the afterbirth is expelled in time. In those 
seventy-four cases the afterbirth was retained in oniy four of 
them at the time of the attack. 

The first symptoms are: diminished appetite, decreased 
or hard defzecation and weakness of the hind legs. The latter 
shows itself by the fact that the animal paddles with the hind 
legs. 

When these symptoms have persisted for several hours the 
weakness of the hind legs increases. Cows which are out on 
pasture show a swaying walk and often remain on the same 
place for quite some time. 

Tn stall-fed animals this persistent standing is also seen; 
they are afraid to lie down. 

Finally, when paresis of the hind legs becomes well ad- 
vanced, the animal is unable to stand up any longer and falls 
down. Sometimes the animal attempts to rise with a great 
effort; and when successful will stand with the hind legs 
spread far apart, leaning against the wall. This only lasts a 
few minutes, when it collapses, not to rise for the present. 

The cow is now in the stage when the veterinarian is 
usually called. On examination the following phenomena are 
noticed, which may be divided into three groups: 


360 BOVINE OBSTETRICS 


1. Symptoms of depression. In the ordinary course the 
animal is soporous, lies flat on the thorax, or upon the knees 
with the head turned to one side. Now and then it moans. 
Occasionally the animal is restless, kicks with the feet and 
shows symptoms of great excitement. The latter are bellow- 
ing and vain attempts to rise, often throwing the head so 
violently against the wall that the horns are fractured. At the 
outset tonic spasms of the extensors of the back are sometimes 
seen (opisthotonos). My experience teaches me that these last 
symptoms call for an unfavorable prognosis. 

2. Symptoms of paralysis. These manifest themselves not 
only in the voluntary muscles, but also partly in the non- 
striated muscles. Paralysis of peripheral nerves also occurs 
frequently. 

The hindquarters always are the first to become paralyzed, 
followed by paralysis of the muscularis of the rumen, intestines 
and urinary bladder. This paralysis is characterized by the 
cessation of the rumen’s peristaltic movement (frequently 
tympauitis), retarded, often hard, defecation (the feces in the 
rectum appear like plates, with bloody streaks, or may re- 
semble peat), and by accumulation of the urine, as the detrussor 
urine muscle: cannot contract sufficiently. In many cases, 
therefore, the distended urinary bladder can be felt on rectal 
examination and emptied by slight pressure. The urine some- 
times contains sugar, first shown by Nocard. Albrecht found 
among twenty-five samples of urine only three with sugar 
and eleven with albumen. 

In parturient paresis, almost invariably symptoms of 
paralysis of the vagus are observed, such as slow and deep 
respiration, frequent pulse and dysphagia. Dysphagia is a 
symptom of special importance from a therapeutic point of 
view. Since the pharynx and soft palate are paralyzed, medi- 
caments (solutions or mixtures) given per os may enter the 
trachea and cause death by setting up a deglutition pneumonia. 
Small amounts of gastric contents may also be brought up by 
belching and enter the trachea. In many animals dropping of 
the upper eye-lid (ptosis) is observed occasionally; also par- 


PARTURIENT PARESIS 361 


alysis of the orbicularis muscle (lagophthalmos). When the 
optic nerve is paralyzed, which also occurs, the animal is 
totully blind. 

In very serious cases paralysis of the trigeminus also sets 
in. The inferior maxilla hangs down, the tongue may also 
hang from the mouth; since the saliva cannot be swallowed, it 
flows continuously from the mouth. 

3. Disturbed sensibility. Sensibility has materially de- 
creased. In serious cases the animals do not react to irritants, 
even needle pricks upon the legs or back. The cornea may be 
so insensitive that the animal does not react when touched with 
the tip of the finger. It may even appear wrinkled. 

The temperature of the body is normal. Rectal tempera- 
ture is usually below normal, since the paralysis of the 
sphincter makes a correct measurement impossible. 

Under the influence of the outer air an apparently very 
low temperature may be present; but when the thermometer 
is introduced sufficiently deep, normal temperature is observed 
(Thomassen, Kruyt, and others). The temperature is unequally 
distributed. Ears and horns, muffle and extremities are 
usually icy cold. 

As the disease advances the cow becomes utterly paralyzed 
and insensible. She lies on her side, moaning loudly; lacteal 
secretion is suspended. Parturient paresis may be complicated 
with prolapsus uteri. This is occasionally seen in cows taken 
sick immediately after parturition, lying low with the hind 
quarters. 


COURSE AND DURATION OF THE DISEASE. 


These cases terminate fatally in six hours after the first 
symptoms become apparent. As a rule it takes longer (twelve 
to eighteen hours). During this time the symptoms may 
increase in intensity until death sets in, or improvement may 
take place at any time. 

It is a peculiar fact, that in some cows seriously ill, 
improvement sets in suddenly; remarkable instances are 
known. 


362 BOVINE OBSTETRICS 


In my former practice parturient paresis was common. 
Especially in villages along the. Maas, where very fine and 
heavy milkers were raised in the bottoms, it was the fear of the 
farmers. It caused such damage that a mutual insurance com- 
pany especially for milk cows was established. To save as 
much as possible the animals were slaughtered early, waiting 
at the same time as long as possible. It sometimes happened 
that the butcher with the knife in his hand waited for the 
last breath, when improvement set in suddenly, the cow rising 
a few hours later. 

One cow suffering with parturient paresis I found on 
repeated visits to grow worse and worse, expecting death at 
any moment. Two hours later she stood in her stall, was lively 
and had some appetite. Nevertheless, such cases are very rare. 
At the same time they show how quickly nerve poisons are 
excreted, supposed to play here an important role. 

It happens that cows with parturient paresis show im- 
provement in 36 to 48 hours, the eyelids open, dysphagia 
diminishes. The animal drinks when a pail with water is held 
under the mouth, defecation and micturition return. The 
general health improves steadily; in the following days it eats 
and ruminates. Paralysis of the hind legs occasionally dis- 
appears after two or three days. The cow rises as usual, 
without showing any disturbances, or sways a little on account 
of the paresis of certain groups of muscles. The latter involves 
usually the extensor muscles of one or both hind legs, so that 
the animal knuckles over a little; this disappears after a while. 

But there are also cases where the animal apparently re- 
covered, but cannot rise for days afterwards. Examination of 
the hind legs shows the thigh and hock of a hind leg swollen 
and cedematous. From the thigh to the shin-bone the leg is 
twice or three times its ordinary size. The swelling is not 
painful, it distinctly pits on pressure. The leg cannot be 
moved, On post-mortem examination, dry grangrene of the 
gastrocnemius, biceps, femoris, and semi-tendinous is revealed. 

Guillebeau and Hess observed two cases of necrosis of the 
deep tibial muscles. In all probability it is the same condition 


PARTURIENT PARESIS 363 


observed by many veterinarians in some parts of Gelderland 
(Holland), and also by myself. 

Guillebeau and Hess look upon this necrosis as a conse- 
quence of the continuous compression of the arteria femoris 
profunda during the preliminary and expulsive period. 

A complication, setting in six to ten days after the animal 
shows already signs of improvement, is gangrene of one pos- 
terior extremity. Some veterinarians in Holland observed it, 
and Thomassen first described it in the Ree. de méd. vét. of 
August 15, 1889. The first symptoms are a swelling above the 
claws. After two days the cleft is moist and a fetid brown 
fluid appears all around the coronet. Soon a line of demarca- 
tion forms above the fetlock around the lower extremity of the 
metatarsus. The peripheral parts have undergone dry 
necrosis. Dry necrosis of the teats (mummification) is also 
seen occasionally. ; 

As sequels, are occasionally observed: Paralysis of the 
cesophagus, ischiatic nerve, paralysis of one fore leg, which 
soon atrophies, and, very rarely, paralysis of the optic 
nerve. 

A very disagreeable complication is the foreign body 
pneumonia. It often follows administration of medicines, but 
also regurgitation of gastric contents at a time when paralysis 
of the cesophagus and pharynx have not yet entirely dis- 
appeared. — 

Prognosis.—The sooner the disease sets in after birth, the 
more intense the symptoms become within a few hours, the 
more unfavorable the prognosis. The prognosis is also un- 
favorable when the disease sets in before or during parturition. 
Those six cases mentioned in my statistics terminated fatally. 

Paralysis of the soft palate and complete unconsciousness 
are unfavorable symptoms from a prognostic point of view. 
The return of the lacteal secretion and defecation (the latter 
not always) are often the first indications of improvement. 
Gangrene of the extremities demands immediate slaughter. 
The rate of mortality in this disease is very great. Statisticians 
give a rather high percentage; for instance: Franck, 40 per 


364 BOVINE OBSTETRICS 


cent.; St. Cyr and Violet, 50 per cent.; Goring, 48 per cent.; 
Ehrhardt, 50 per cent.; and in my statistics, 66 per cent. 


PATHOLOGICAL ANATOMY. 


Post mortem examination reveals a contracted uterus and 
the symptoms of a normal process of involution. The large 
intestines are usually filled with dry faces; no inflammation 
is present. Those cases in which imflimmation of the small 
intestines is observed in all probability depend on puerperal 
infection (see further down). 

The omasum contains a great deal of dry food. The liver 
is always of a lighter color, but this is also met with in cows 
slaughtered for other reasons—for instatice, in cases of fatal 
hemorrhage due to rupture of the uterus. The kidneys are 
mostly normal; occasionally parenchymatous inflammation is 
noticed. The large bronchi sometimes contain some feed; 
some animals show a foreign body pneumonia. The deep 
muscles of the thigh are occasionally necrotic (Guillebeau and 
Hess). 

The changes in the brain are variable. Harms (also 
Bormann) found small round air bubbles in the veins of the 
pia mater. 

In some autopsies large quantities of transparent serum 
were found under the dura mater and in the ventricles. 
(Harms, van Dulm). 

Van Dulm and Hannel observed decided injection of the 
cerebral vessel, with extravasation, in consequence of which 
the cerebral substance exhibited a hemorrhagic infiltration. 

Most autopsies are conducted on slaughtered cows. Thus 
the bleeding gives a more favorable anatomo-pathological 
picture, than if the animal had died. This must be given 
due consideration when the meat is to be consumed. There 
are also cases of acute puerperal septiczemia in which the 
uterus shows but few microscopic changes. The latter are 
often very dangerous, as the following case shows : 

On October 17, 1890, in the morning at 10 o’elock, 8. at V- 
requested me to visit his cow. She had given birth to her 


PARTURIENT PARESIS 365 
fifth calf and was in fine condition. An easy and normal birth 
took place six hours previous to my arrival. The calf was 
alive. The afterbirth was still connected with the uterus. 
The cow exhibited the following symtoms: appetite and 
rumination were suspended, lacteal secretion limited, faces 
hard; the cow swayed to and fro and threatened to fall down 
at any moment. After the weakness of the hind quarters had 
greatly increased, within a few hours the animal fell down, not 
to rise again. She was lying on her knees, the head resting 
against the thorax, moaning londly. The vulva was not 
swollen. Diagnosis—Parturient paresis. The afterbirth was 
expelled during the afternoon while the cow was comatous. 
Toward evening the symptoms became so intense that the 
animal had to be killed. 

The autopsy was held on the following morning. The 
uterus revealed no metritis, the brown, slimy lochiz were 
perfectly inodorous. The serosa was normal; the involution 
corresponded to the post partum stage; the liver was slightly 
yellowish, but very consistent; the spleen normal. The colon 
normal filled, its contents rather dry. The small intestines 
were filled with thin, brown manure, the mucous membrane 
injected, here and there small hemorrhages; the submucosa 
wus somewhat swollen; the vessels of the serosa were injected. 
The kidneys were normal, having a few petechize in the cortical 
layer. The lungs were collapsed, slight hypostasis on the left 
side, bronchi and trachea normal. The endocardium near the 
valves and the valves themselves were covered with a few 
petechiew. The vessels of the pia mater were distended ; the 
ventricles contained a transparent liquid. 

I condemned the meat mainly on account of the enteritis, 
fearing that possibly an acute septicemia might have existed, 
while the anatomo-pathological picture was hardly sufficiently 
pronounced to confirm such a diagnosis. 

Before the meat could be destroyed some meat. from 
‘the hind quarters was sent to a neighboring family, who 
had cooked and ate it. All who had partaken of this 
meat became ill with acute gastro-enteritis (one party even 


366 BOVINE OBSTETRICS 


with bloody diarrhcea). After a few days all the patients 
recovered. 

Therapeutics.—It is natural that in a disease of which the 
etiology is so dark, the methods of treatment are numerous, 
the curative agents multiple, and the results of their admin- 
istration variable. 

Prophylaxis.—Experience teaches us that extensive feeding 
and a long period of dryness in cows calving for the third, 
fourth, or more times, predisposes to the disease. Therefore 
many advise to give fat, lymphatic animals in the last stage of 
pregnancy intensive but not voluminous food, and to shorten 
the period of dryness as much as possible. 

In case pregnant animals are out on pasture in the summer, 
they should not be brought into the stable to calve, but partu- 
rition is best allowed to take place in the open air. Many 
stock owners through practical experience live up to this rule. 

Thomassen, Walther and others recommend as prophylaxis 
to milk fat cows and heavy milkers before birth. Venesection 
on the day previous to parturition, the administration of pur- 
gatives, for instance, Epsom salts, are also suggested as prophy- 
lactic agents. While practicing in localities where parturient 
paresis was common, venesection was often practiced. I have 
never seen any evil results from it or large doses of Epsom salts. 


STANDARD RULES IN THE TREATMENT OF PARTURIENT PARESIS. 


The cow must lie straight, that is, upon the flexed knees 
and hocks, and a little on the right side. In this position tym- 
panitis often disappears, quite marked while lying flat on the 
side. When the animal is too restless to stay in the straight 
position the body must be banked with bundles of straw. The 
animal must always be watched. It happened that a cow 
which moved forward, wedged the head into a corner and 
suffocated. 

The urine is to be drawn from the bladder. Ordinarily it 
suffices to pass the finger into the urethral opening; when 
necessary, the catheter is used. Also by pressing upon the 
urinary bladder from the rectum it may be evacuated. 


PARTURIENT PARESIS 367 


The manure accumulated in the rectum is removed with 
the oiled hand. 

Repeated milking. The cow is to be milked every three or 
four hours. Rubbing of the back and loins with stimulating 
medicaments, as linimentum volatile, linimentum ammoniato- 
camphoratum, ete. The legs are rubbed with straw wisps to 
stimulate cutaneous circulation. The number of medicinal 
agents employed in parturient paresis is very great. On 
account of the paralysis of the soft plate and danger of a deglu- 
tition (pneumonia), it is not advisable to drench such animals. 
Only when personally convinced that the animal can swallow 
and giving the medicine ourselves, drenching is permissible. 


MEDICINAL AGENTS FOR SUBCUTANEOUS INJECTION. 


Here excitants are indicated, as alcohol, ether, spiritus 
camphoratus, caffein. In case the hind quarters remain para- 
lytic for some time, strychnia is used. 

Cocaine (1 g. to 10 g. aqua) has been used subcutaneously 
with success. 

Bauwens employed nitroglycerin in parturient paresis 
internally and subcutaneously. The subcutaneous applica- 
tion (5 gr. of 1 per cent. solution in alcohol) yielded good 
results. 

Medicaments influencing involuntary muscles are fre- 
quently employed in this disease, as eserine, pilocarpin, arecolin 
and veratrin; especially pilocarpin gave good results (Haubold, 
Anker and others). Hiurlimann injects 20-30 g. of pure 
ammonia on either side of the neck. He orders the animals 
taken into the open air and irrigates the uterus with a warm 
disinfecting solution. 

Rectal medications, such as cold water clysters, solutions of 
Glauber salt and sodium chloride, are named. Some recom- 
mend a decoction of tobacco. 

Hydrotherapy. Hydrotherapy is frequently practiced in 
parturient paresis. Hartenstein saw very good results follow 
the irrigation of the cranium and spinal column with cold water. 
For this purpose a linen sack was put upon the head and loins 


368 BOVINE OBSTETRICS 


and kept moist with water. He also practices venesection, 
giving a purgative (aloe 30 g., asafoetida 10 g.). 

Priessnitz’s fomentations are also often used. Ehrhardt 
advises to cover the body with a wet linen cloth and over it 
woolen blankets. The fomentation is renewed every hour. 

Venesection is practiced in this disease by many veterin- 
arians (Hartenstein, Ehrhardt, etc.) Electricity has also 
been employed a few times. 

Anker (Holland), who treats every year many cases of 
parturient paresis, follows a method by which the rate of 
mortality decreased materially in localities where he practiced, 
It is as follows: The position of the cow must be a natural one, 
not upon the thorax but on the knees. Subcutaneously 300 to 
500 mg. pilocarpin are injected. A sack is laid upon the loins 
and continuously kept wet with cold water. When the animal 
is restless the head also is cooled. By keeping the loins and 
cranium cool the animal becomes quiet. When dysphagia is 
present he avoids drenching. When deglutition is normal a 
drench of herba nicotina with aloe and Glauber salts is admin- 
istered. Twelve to fifteen hours after the first injection another 
300 to 350 mg. of pilocarpin are injected subcutaneously. The 
animal is changed alternately from one side to the other and 
milked. When the disease has disappeared so far that the 
animal after three to twenty-four hours eats, drinks and rumin- 
ates, but does not rise, it is assisted in getting up, and the legs 
washed with cold water. Anker lays special stress upon the 
fact that the animal is assisted to get up, as it should not be 
omitted. He never saw any evil results follow the cold irriga- 


tions. 


DISEASES OF THE YOUNG CALF. 
1.—Asphyxia Neonatorum. 


It happens now and then that the calf is born in an 
asphyxie state. This condition occurs when the foetal blood is 
wauting in oxygen, respectively laden with carbon dioxide. 


ASPHYXIA NEONATORUM 369 


Aitioloyy.—. Violent uwerine contractions during the pre- 
liminary and expulsive stage. As a consequence of an early 
rupture of the foetal membranes, the uterus contracts, the 
placental circulation is disturbed, so that death of the calf 
may follow insufficient blood supply. 

9. Retarded expulsion. When head and fore legs are in the 
pelvis, the allantoic fluid is mostly discharged and the uterus 
contracted to a certain extent. Should disturbances be present 
in the parent or young, interfering with birth at this moment, 
the blood supply from the placental vessels is no longer suffi- 
cient, and dyspnoea results. 

When one-half of the calf is born—that is, when the 
anterior half of the body is born—and the trochanteric diameter 
lies in front of the pelvic inlet, or when in the croup presenta- 
tion the hind legs lie in the parturient passage, the navel 
string usually tears quickly and the placental blood supply 
ceases, dyspnoea being the result of a retarded birth. 

3. Inspiration of amniotic fluid. Compression or rupture 
of the navel string causes inspiratory movements. In conse- 
quence of it amniotic fluid, especially in the croup presenta- 
tion, may enter the air passages, thus interfering with the 
entrance of air. 

Symptoms.—When the calf is born, the owner is soon 
inclined to look upon it as dead in case no inspiratory move- 
ments are noticeable. Nevertheless it is possible that the 
young animal can be saved by proper treatment. In most 
cases of asphyxia respiration immediately after birth is deep 
and slow, with long intervals. The heart’s action often is very 
weak. Movements of the voluntary muscles are frequently 
wanting. This state may persist for ten to fifteen minutes; 
when respiration becomes less deep and slow, the heart's action 
becomes stronger and some inspiratory movements with a 
rattling noise manifest themselves. During the asphyxic state 
death may occur at any moment. 

Therapeutics.—First the amniotic fluid must be removed 
from the mouth. This is best done with the fingers. Often 
the tenacious slime can be removed in the shape of a long 


370 BOVINE OBSTETRICS 


stopper. The treatment proper endeavors to stimulate the 
respiratory centre reflexly. 

This may be done: (a) By irritation of the cutaneous 
nerves by rubbing the skin with straw wisps, or by carrying the 
wet calf immediately into the open air. Although stock 
owners object, it is nevertheless an active irritant. ()) By the 
application of cold water to the cranium between the ears or 
upon the umbilicus. This is simply done by allowing a stream 
of water from a height of 1 meter to fall upon those parts. 
(c) By artificial respiration (Albrecht). This should be con- 
tinued for some time, five to ten minutes and possibly longer. 
(d) By electricity. Franck and Albrecht advise to place the 
electrodes close to the first ribs (irritation of the phrenic 
nerve). (e) By strong, rhythmical traction on the tongue. 

Mytile tried the method, successfully practiced by 
Laborde, to revive the apparently dead, drowned ones, on an 
apparently dead calf. After pulling a few times a strong 
hiccough was heard, eventually turning into regular respiratory 
movements after a few more pulls. 

Bauwens gives } g. of 1 per cent. nitro-glycerin solution 
subcutaneously and practices artificial respiration. 


2.—Persistence of the Urachus. 


When the navel string is torn the fundus of the urinary 
bladder closes and the urine no longer flows through the 
urachus. Occasionally it happens that this physiological pro- 
cess is disturbed, and in consequence of it the urine drips from 
the unbilical opening. 

The diagnosis is easy. The umbilicus is hot and swollen; 
the hair all around the umbilical opening is wet and sticks 
together. When of some standing the hair of the anterior 
and inner surface of the hind legs drops out and the skin 
becomes inflamed. The opening leading to the urinary bladder 
is just wide enough to allow the passage of an ordinary probe. 
The edges are slightly elevated and exhibit a granulating 
seam. 


FATAL ENZOOTICS OF CALVES OL 


- Prognosis is favorable. 

Therapeutics.—The purse suture is the simplest means to 
obliterate the opening. The opening may also be closed by 
searing, using a probe pointed iron at white heat. A more 
persistent eschar may be produced by putting some colopho- 
nium over the opening before searing it. 

Cauterization with lunar caustic or copper sulphate is also 
successful in many cases. 


3.—Fatai Enzootics of Calves. 


This designation comprises several diseases differing in 
causes, symptoms and course. Of these the four principal 
infectious diseases are: dysentery, septic pleuro-pneumonia 
of Poels, septicemia of Jensen, and bacteriamia (hemorrhagic 
nephritis and cystitis) of Thomassen. 


(a) CALF DYSENTERY. 


Calf dysentery (yellow or white dysentery, dysenteria 
neonatorum) is an infectious disease attacking the young 
animal in the first few days after birth, showing usually an 
acute, frequently fatal, course. 

Aftiology.—Already Franck describes this disease as an 
infectious one, and supposes that a stable miasma must be 
looked upon as the cause. The fact that some calves are 
already diseased before they suck suggests that such calves 
were already infected before birth. 

Nocard showed that dysenteria neonatorum and the infec- 
tious abortion in all probability are caused by one and the 
same low organism (see infectious abortion, page 115. 

Besides Franck and Nocard, Friedberger and Fréhner 
also believe in intrauterine infection. The latter are of the 
opinion that infectious catarrhs of the uterus or vagina are 
transmitted to the mucosa of the digestive tract of the young. 

Jensen thinks that there is hardly foundation to prove 
intr-auterine or vaginal infection. Jensen found an oval 
bacterium in the blood, mesenteric glands, spleen, also in the 


372 BOVINE OBSTETRICS 


liquid of the kidneys, liver and lungs, obtained by squeezing 
them, finally in the blood of the heart. Especially in sections 
of the spleen and kidneys the bacterium was found lying in 
little masses in the smaller vessels. 

Jensen further states that when he fed a culture of the 
oval bacterium in milk to anewly born ealf or one but a few 
days old, this dysentery ended in death in one or two days. 

According to Jensen, the calf dysentery bacteria are oval, 
a little larger than the microbes of chicken cholera, lying 
singly or in pairs, occasionally forming short chains. They 
do not take Gram’s stain, but stain with ordinary aniline 
colors. They are facultative parasites and are related to the 
bacterium coli communis and bacillus foetidus lactis, also 
described by Jensen. 

Jensen came to the following conclusions based upon his 
investigations: Calf dysentery is not a simple inflammatory 
state of the digestive canal, but an inflammation complicated 
by a septic state produced by the entrance of bacteria into the 
circulation. 

The cause of the disease is not a specific infectious agent, 
but a pathogenic variety of a form of bacteria normally found 
in the intestinal contents. 

Piana found a microorganism in the blood, the intestines 
and in the lumbar portion of the spinal cord, supposed to be 
identical wlth the bacillus coli communis. His experiments 
with these cultures remained negative. He believes that the 
cultures rapidly lose their virulence, or that the calves have 
greater powers of resistance a few days after birth. 

Monti and Veratti also believe that the short bacilli (1.2 x 
0.7 ), found in this disease, are closely related to the bacilli. 

Galli-Valerio mentions that Piana and Monti, as well as 
Veratti, Mazzanti and Vigezzi (the latter found in the umbilical 
vessels, intestines, liver and brain, an oval micrococcus or dip- 
loeoceus of 0.0015 x 0.0008 mm.), probably dealt with a variety 
of bac. coli communis. 

The investigations of Walther and Schild prove that 
bacteria may be found in the intestinal contents of the new- 


FATAL ENZOOTICS OF CALVES 373 


born before they have taken nourishment. According to his 
opinion, the first infection of the intestinal contents takes 
place independently of food by various bacteria, also pep- 
tonizing ones. At the earliest infection occurs four hours, 
at the latest twenty hours, on an average ten to seventeen 
hours, after parturition. He also proved that in a child infec- 
tion per anum is due to the bacillus fluorescens, the porcellain 
coccus, the bacillus subtilis and proteus ; infection per os is 
caused by the bacterium coli and the bacillus fluorescens 
liquefaciens. 

Symptoms.—In some cases the owner observes a few hours 
after birth, but in most cases one or two days, that the calf 
strains slightly and exhibits some tenesmus, and that the fxeces 
are thin. The liquid feces in the beginning are yellow, some- 
times orange colored and fetid. Later the manure is discharged 
involuntarily, is gray like slate dust, and thin as water. Suck- 
ling is limited or entirely suspended. The calf is soporous, 
the muffle, the ears and extremities are cold, the walking sway- 
ing. Ata later stage the eyes sink back into the orbital 
cavities, and 12 to 24 hours, occasionally 36 to 48 hours, from 
the beginning of the diarrhoea death takes place. 

Jensen mentions as Morkeberg’s observation that the 
disease sets in with severe stretching at times of a distinctly 
convulsive character. The rate of mortality in this disease is 
very great. Friedberger and Fréhner give it as 80 to 100 per 
cent. 

Pathological anatomy.—Pathological changes are found in 
the abomasum, intestinal canal and heart. According to Jen- 
sen’s description, the gastric mucous membrane is injected and 
full of small hemorrhages. The mucous membranes of the 
small intestines, caecum and colon are mostly of a uniform red 
color, due to numerous small hemorrhages; here and there 
desquamated epithelium is observed. The folds of the rectal 
mucosa are especially hyperemic. The mesenteric glands are 
swollen and exhibit hemorrhagic infiltration. The spleen is 
normal, the liver and kidneys somewhat hyperemic. The 
heart shows occasionally ecchymoses. This picture agrees 


374 BOVINE OBSTETRICS 


fully with the alterations noticed by many investigators of 
this disease. Sometimes pneumonic foci, deglutition pneu- 
monia were found (Morkeberg, cited by Jensen). 

Therapeutics—Prophylaxis promises here more than thera- 
peutics. Franck already in 1876 advises to place pregnant 
cows, four to six weeks before their term is up, into another 
stable, the floor of which has been disinfected previously. 
Goring, besides, suggests thoroughly cleansing the abdomen 
and the legs of such animals, and to wash their udder with a 
2 per cent. carbolic acid solution and to take care the infec- 
tious material is not transmitted by an intermediary. 

Morkeberg decreased the rate of mortality from 77 to 33.3 
per cent. by analagous measures and by feeding pure milk from 
an udder first washed with sublimate water. The young 
animals are treated with antiseptics (1 to 1200), creolin, naph- 
talin, thioform, salicylate of soda and salts of bismuth. 

Some practitioners had good results by administering 
slimy agents with opium (mucilago saleb with opium). Many 
use the remedy recommended by Hertwig, magnes. carb., pulv. 
rad. Rhei and pulv. opii; also tannic acid and silver nitrate 
(4 per cent.) are used either per os or as clysma. 

No matter which remedies are employed, it is always of 
importance to keep the calves warm and to stimulate cutaneous 
circulation by rubbing with straw wisps. 


(b) SEPTIC PLEUROPNEUMONIA OF CALVES. 


Poels first described this disease, quite common among 
calves. It has the character of a septicemia complicating itself 
with pneumonia and pleurisy. Poels found in this disease 
specific bacteria, pure cultures of which produced the identical 
disease in experimental calves. On post-mortem examination 
of these experimental calves the bacteria in pure cultures, 
virulent and in large quantities, were found in the blood, 
internal organs, pleuritic and pneumonic exudates. 

The pure cultures killed mice, rabbits, guinea pigs and 
young bovines. In swine they may produce a disease resemb- 
ling closely swine plague. 


FATAL ENZOOTICS OF CALVES 375 


The cultures and their pathogenic effects simulate strongly 
the bacteria of rabbit septicaemia (Gaffky), septicemia hemor- 
rhagica and swine plague. 

The bacteria of septic plearopneumonia may enter through 
the diseased digestive canal and through the umbilicus (as well 
at the time of birth, when the umbilical vessels tear, as in 
omphalitis). 

Poels also states that these micro-organisms may live 
some time in the umbilical vessels. When the thrombus in 
these vessels undergoes putrefaction, the danger of a general 
infection becomes marked. In these cases it may happen that 
nothing abnormal is noticeable in the umbilicus. 

Infection may also take place through the organs of 
respiration and excoriations of the skin. 

Prophylaxis.—Poels recommends. the following: Calves 
with diarrhoea must only be fed boiled milk during this disease. 
The milk vessels must not be cleansed with unboiled water 
from ditches or brooks, as practiced by some farmers; the 
putrid liquid discharged from the vagina in cases of septic 
metritis must also be taken care of. The animals easily infect 
the udder with the tail, from where the bacteria get into the 
milk pail when the animal is milked. This fluid sometimes 
contains the bacteria of septic pleuropneumonia. Therefore it 
is certainly indicated to keep the udder clean, respectively 
cleanse it mechanically with soap and warm water. 

The umbilicus during and immediately after birth must 
also be treated antiseptically. 


(c) CALF SEPTICHMIA (JANSEN). 


Jensen observed a disease among calves in Denmark. The 
specific cause, according to his investigation, is an ovoid bac- 
terium. These correspond morphologically and biologically 
with the microbes of chicken cholera, septiczemia hemorrhagica 
(Kitt), and swine plague. Only their pathogenic properties 
show differences. According to Jensen, it is closely related to 
Poel’s pleuropneumonia, but runs a more acute course without 
showing any inflammatory processes in the lungs. The calves 


376 BOVINE OBSTETRICS 


die within 12 to 24 hours after the first symptoms of the dis- 
ease become manifest. These are sudden illness, the animals 
are unable to stand, the temperature is very high, about 41 
deg. in some cases; there is dyspnoea and diarrheea. 

The autopsy in some calves revealed a violent acute 
fibrinous pleuritis and peritonitis, also gastro enteritis and 
numerous ecchymoses under the pericardium; a tumefied 
spleen and gelatinous infiltration about the larynx and pharynx; 
often also a phlegmonous inflammation of the posterior por- 
tion of the buccal cavity was found (Jensen). 


(d) BACTERHMIA (HEMORRHAGIC NEPTRITIS AND CYSTITIS), 
(THOMASSEN). 


Litiology.x—The cause of this disease is a short bacillus 
found by Thomassen, resembling in form the bacillus typhi of 
man, as also the bacterium coli commune. From the latter it 
is distinguished by its great virulence. Even known pathogenic 
coli bacteria, as found by Jensen in calf dysentery, are not as 
virulent as this bacillus. 

It is differentiated from the bacillus coli communis by: () 
its greater mobility; (}) its peculiar growth on potatoes; (c) 
its limited power to form carbon in saccharin bouillon and to 
develop indol out of pepton; (d) its inability to coagulate 
milk even in weeks; (e) the absence of fetid air on opening 
dishes in which gelatin plate cultures developed for some time. 

Thomassen produced the disease experimentally with pure 
cultures either by subcutaneous inoculation or feeding of 
bouillon cultures. The following I have taken from his 
description : 

Symptoms.—The calves are born healthy, showing the first 
symptoms in five to eight days, occasionally some weeks, after 
birth. They become listless, lie down all the time, and when 
forced to rise, they stretch, tucking in at the same time back 
and loins. 

The muffle is dry; respiration frequent, 50 to 120 per 
minute; the pulse is small, 100 to 150 beats per minute; tem- 
perature 104 to 108 deg. F’. 


FATAL ENZOOTICS OF CALVES SUL 


Some animals exhibit occasionally a severe and dry cough. 
The appetite has decreased, but the animal takes a little milk 
up to the last day. 

Feces are normal, rarely diarrhoea. The urine is evacu- 
ated frequently and in small quantities. It was mostly turbid, 
and contained albumen, bladder epithelium, casts and the above 
named bacteria. 

Some calves show cerebral symptoms, as tonic and chronic 
spasms. Later paralysis sets in. 

Course.—The disease extends over five to six days, always 
terminating in death. 

Pathological anatomy.—The spleen is five to six times its 
normal size, weighs 1 pound, it is full of blood, of chocolate or 
black color. The spleen occasionally is irregular in shape 
when one part is more swollen than another one. A smear 
made from the spleen shows many bacilli. The kidneys show 
a hemorrhagic, parenchymatous inflammation. The mucosa of 
the bladder is colored brownish-red or sometimes in streaks or 
spots. 

The mesenteric glands are enlarged, exhibiting many 
hemorrhages. The folds of the abomasum show dark red 
spots, also seen here and there on the mucous membrane of 
the small intestines. Peyer’s patches are swollen. The liver 
is undergoing parenchymatous degeneration. The endocardium 
is covered with many red spots. The central nervous system 
is mostly normal. Occasionally a meningitis serosa, and in the 
exudate bacilli and leucocytes, are found. 

Therapeutics.—Thomassen tried successively: carbolic acid 
2 per cent., eucalyptol (1 to 10 in oil), ioditrichloride (1 to 1000, 
as much as 2} ounces daily) and Lygol’s solution subcutane- 
ously and intravenously, without any results whatsoever. 





INDEX. 





PAGE 
Albortions.. saccecs cclesae cco lO? 
aruiticiallereereceiere Feewlaaheos 211 
indications...... sblsioeue Ll: 
procedure....... Arnot es 

sequels ........ 560006 213 
Gefinitionlolfancseccees on lOT. 
ONZOOLIC Mace ees es SSAC 108 


INLECHOUSH toc enclecee ee LLO 
WHOLOLY: cassicseasieas lS 


sequels ..... siaeieseniankee 
symptoms...... Sate 
treatment.........22. 123 
non-infectious........... . 108 
POCIOLOPY Ei ssicteissclacwle 108 
prognosis ............ 114 
symptoms ......... So. abil! 
treatment............ 115 
INCATOIACUS fai ajeisi2 Satis cecisieiers ee 200 
Accommodation theory ..... peat 
Afterbirth, retention of....... 108 
GALISES ereetel-iteleleyee Bisieteleiere 326 
MIACOTALION)) ails ues bac 328 
BEMMIEIS: crelerein eyecare civ areiscete 328 

SY MPLOMS. .\ ce cis iclclee cles 327 
treatment............ ree O29 
INFO PANS (cic cis: cis cess ecisee = 76, 82 
Alllantols: Ssicigcsis cine eouloes 15, 21 
SAAN WIQUIOT cic\s!¢/efelc/ofele tions aes 19 
PANIIT TON eiererimiers orate stetem ears 16, 19 
PATIEOIIAID er ctetote siersre sie eroe reine e's 44 
Anasarca, foetal.............. 197 
Arteries, umbilical........... 78) 
Ascites; foetal... Sa.-ci6i vie ks os . 42 
BLIOLOLY sevicicias oes welce's 197 
diagnosis........ ste LOM Oo 
treatment .......... Sooog tlle! 
Asphyxia neonatorum........ 368 
Auscultation, obstetrical...... 38 


379 


PAGE 


Bacillus, anthrax ......2..0.. 29 
glanders...... statelcvalesiatelers 29 
tuberculosis cise cece e 29 

Bartholin glands......... eeretge O 

Belly, mensuration..... Sete oO 
Pal pation -ieicishies emia eetere 37 

Birth, normal, its course. .46, 58, 63 

Birth, premature............ 23 


Botallitductc sess ccccccesneeee 


Ceesarean section..... ausialeete stra ea 
after treatment..... aereor eal) 
indications ......... slefenieee 
procedure....... “Lnesodde 218 

Care- newly; DOr: sicsccecce ch tt 

Carunculeey ss. sicic: ssc Sscodouon | iil 

Cervical canal...... HOSBOOTOS 177 
obliteration ....... pereteteteis 177 
BEMIS Tele Ae ciercleteleie steers «6 178 
SYMPTOMS eile vlececccces Lit 
treatment........... Sd aoo ile: 

COrvixs Uber is iesiesre oon ee 173 
morbid changes.......... 173 
treatment.......... s40600e 174 

Chorionswallieeee sc des 16 yaa ls ya i" 

Circulation, placental........ 61 

Comblomeisizciae conics ele oeciercle e's t 

(Colostrumlcnyers et slslsicverlei overetocs 2, 80 

COlpMIS Aa sialon feiese eee ees 5, 180 

Conceptions. scciscielccitecis os 1, 4 

WOrpus MITCUM s/.0:5)4 «as « 0's, 5/508 3 

Cotyledonous fluid........... 18 

Wotylegons ess << cele ccc siciy eve 11 

Cow, when to serve.......... 2 

CFANIOPACUS ss 5-50; 0 11s 5:0 6,0 0'0) aime 200 

Cyst, atheromatous.......... 43 

DrvepHalusie snc. v «case sss .» 204 


380 INDEX 


PAGE 
DiprosOpus....55 60 0.ceceesess 204 
IDM ine ee nepacdmooduscneDe 200 
DOLOLBS secloreetcts cietaeso were orale aloe 60 
Double-endereec. cece <> a1 184 
Dryness, period of... ......... 36 
Ducts @fAntit ws coe os ccs 26 
Ductus omphaloentericus..... 22 
Dy SP OOa erste ntesal-ohete e isie eseinor=eie Te 
Dystokia...... Foianiaatt ptememieyert le 
Ecchinococcosis...... ei tapisve mis 20 
HiGbOGerinty.2.ri-/usisisteiisi= ResGe Od at 
Elytropasmus.........secceece 6 
Embryotomy.........c¢- Sas¢6¢ 260 
complete......... Sonobodc 281 
definition .......... preirnicis 262 
general rules............ 263 
TNATCARIONS ete piers lalelsleisioveyeie 262 
Bndomiepritiss-r--i- + sracitoitee's 7 
acute catarrhal.......... 332 
POLLOLORAY; ceieie wseke oheivwloie 332 
SVM LOMS ia )-rote'eicipclees 333 
Geis cadadaccogucnase 334 
POLO LVN a eccieleoeleiarein B04 
sequels)... ¢2. <i.» eoee Bot 
SVAN LONI eciarcicidieiee ele 334 
treatment...........- 335 
BUthOR Tai sya eyeltiers ate cava aleiaieteere 46 
Expelling powers, abnormali- 
HSI an 000505 SOS AB OO NmOIoo. 181 
HRA SIOV a ris eis clalolniele ah sin bom 67 
Hallopien TO oie o\5.1s's10's ao. o sole 11 
Hlanke fallin OL se... . ae: 65 
Foetal dimensions............ 69 
TS ANb WEALS ste icicas oictencie osteo 39 
membranes, dropsy of.... 135 
expulsion of ......... 81 
IMOV.OMONUES aeleisisielcive sie.s\e'¢ 37 
HO@HUS! oi ciechahes eet cisiewsies 7 
abdominal position...... 221 
BLO OL, \oitedianienmitaniesrs 23 
ANACOM'Y Ole wratenveinias eines 29 
ANNEXES Olveiteu renters 15 
CISEASES/ OL iss ten es opslpariere 125 





PAGE 
Foetus; dropsy. Of. .<.c..6 20si=. 195 
GLOpSy#OL, DEAN ss... =k oe == 195 
emphysema of........... 189 
ebIOlOgy % as.0c cms 50 - 189 
GCOUTSChe a eiclsts winisiersiplore 190 
delinition ‘sews v~ os 2% 189 
operator’s prophylaxis 192 
Symptoms)... seas 190 
treatment... . <6 2<..> 192 
intra-uterine position of .. 30 
IMACELAM ON actoisteraloteislels sisi 129 
PTWOLO LY aig seienreeints ores 129 
CefinidlOn cerieisietesietete 129 
SV MMPLOM Sis. soles eie 130 
treatment............ 131 
mal Positions!.7- cere es 221 
GIASMOSIS Ole -.1e teres 225 
mummnification of........ 125 
PUOLOLYaenes.t eee 126 
definition:.;.'ss<sveleie 125 
Syst PLOMAee ec - ceiee eers 127 
treatment............ 128 
HWCMUON Ol avesweenie cee 25 
Operations ON .......e..s. 221 
PLESSUTO LONG. moieties 62 
TEPOSItION Of .....cescccees BOL 
00 Tar is. becteeeeneienlevee 183 
course of parturition. 184 
treatment......:..... 186 
when dangerous to opera- 

DORE sieinsteccieiutane ees 222 
HOPAMEN OVAL we scsnctee eres 27 
MOSSAVO VAISS cleanest. 27 
Fractures during birth ....... 298 
Bree Martine (7s < arcs elaleisrcic’s 32 
Ui Tau ASE AR OOo me ob AAD 22 
Genital passage............. 56 

WNLECTION OLE, nie ciatvisiv'eve ne AO 
Gestation, paralysis of ....... 99 
Glands, uterine.............. 14 
Graafian follicles ...........«. 3 
Graviditas, extra uterine..... 140 

ADAOMINBLB Nic ciate eres bese . 141 


OVATIGUISAY calsinies cnletemiwisle: » 141 


PAGE 
Graviditas tubaria..... So 141 
Gravidity, abdominal........ 141 
EG UTSO :a25, 5,5, aycsacaltore teakata takers 141 
IAL TIOSIS -rjeierencrelete stars stekets 142 
treatment...... sieeleve steletare 142 
Gravity theory..............-- 71 
Gunther’s porte cord......... 230 
shui liseeoannaboooucbonSGOe 20 
Hooks, obstetrical...........- 231 
iy ATOM Ais creteleteleinds cteloteteds|eielet= 44 
Hy drallamtorststiejencrc-te oeiisteiers 135 
Falty CUATATMIOS = -'<)0; a.0'stotae es (erer 82, 135 
REIOLOLY: sa oe ces owe ns 136 
GOH MUON iercrelsnclatelaerere oe 136 
GIASMOSIS) weiels cieisieiove sein 137 
differential diagnosis..... 138 
EVA oNOalshe -Bbadgodoc Se 157 
treatment) .):-/)sic8 soi elec 139 
Hydrocephalus; 466.05 0,...0% 195 
SYMP COMISS perce earslerelelelelera~ 195 
GLCAUIMIUCIMU:ccraysraleisicietclersiel vere 196 
EP YSLCTOCELO ois 5) operas & sree. oie's 164 
Hysterotomy, vaginal........ 208 
AMALOTIY: eto ks Lavajoie)sietcereis 208 
Gefimitlonee facia etcisie sa 208 
details of operation....... 209 
IMOIGAMONS. Weee eerste ictelerors 209 
SEMMICIS yercveteleisiai speteiers stareclote 211 
MNGTTESHOMS jess seh ere ms fiers 45 
diner tia puberive et eisiescieise sie tere 85 
Infection, puerperal.......... 336 
CB CONOS po onaoue spouse oOo 344 
Intoxication, puerperal...... 300 
due to retained lochiz.... 350 
ISChiopa muse tet aciatisleelsiel=ciare/- 200 
MGA OLN AMM sr taterstc iol vic) nists so neji 60 
WA PALOCOMAY ya ctelsislsineles clsjeiele 214 
ClSrhouinbinancpiauSAsa Aa 214 
INGICAONG Ais seis cece ss 214 
DEOROG NRC s rc rates care e nim el 214 
SUUMEOss a trerelsieaiatsieleteloiieiciate 216 
Mardy caltiinaacate cveeccc scale ciels 198 








INDEX 381 


PAGE 

 Taithopzedion .....-....--- 125, 141 
i LOG ERS GaGU ee BEDCOROCICO UIC 83 
Loweri tuberculum .......... 27 
Luxations during birth... .296, 298 
CAUISGS ue ereieisie sole sie care ele ee 296 
SYMMPLOWIG! seco cpio alos ele 296 
PNEALMACIIG. ea iorcieistetale o1o-s/erete 298 


Mechanical obstetrics, auxili- 


ATE SHCMENEUO eis ais clerelciel neon 290 
MeCOnMMIMN ss. 2) e.< siciee ore 20, 29, 80 
Menstruation <5. <2\2< ts sen 2 
MesOmetriuUmMl. i. scl =| <1ecs else 7 
Metritis, septic............... 338 

PHAOLO Gi siohe)s.cs oc odseaar es 339 

definitionees seh set ees Oo 

pathological anatomy.... 339 

BymMptoms ........606...- gag 

GLCADIMENG . <ojera osteo eles 340 
Metrorrhapilaiiey. aie2.cl1= 5019/6. 33 
IMetrotomiy terion -:s-scrte ser 219 

BUNUN G renee elatetonoienstersiatereieiers 220 
IMOMSTEOSITIOS sijeisvere eraicteicie )aleye 200 

SYA OWS ele eralete)ol<rel ets (ease) 201 

treatment.......-: 202, 204, 206 
MothbervcareOlys vaca levers os. 0/6 224 
INAIVeMIS ERIM Dies ei oc cies ve 6.0 22 
Normal pregnancy... ....... 1 
Olsens. bs Sacauads aoodondos 43 
Obstetrical phantom ......... 290 
GH stastumasisieiseccioa coe arse se vier 1, 2, 34 
Omphalo-mesenteric vein..... 29 ° 
OPeraAtlONs-.¢ <0. in =. wees wfe'e,e 298 
@steomalaelanrs s:. <1. <i ene a 44 
Osteopedion ............06-4% 125 
Os uteri, dilatation of........ 65 
Ofniere CHL Sa Saigon Popes be 200 
‘Ohyslvicinesicdddieddeadcec 6Onmsr 5 
(@yyaueraareyeropetcletesretesaies-vorsresemelratate 3 
[Parise falset\cnjosesinetsieoee sive 175 

treatment,........... 176 


FEOWO oe sar eheionarelcinterel suue lace 181 


382 INDEX 


PAGE 
Pains, preparatory .....+..... 62 
XU) SiO ater yerstsroletaleleleinttais 63 
post-partum........-..e0- 63 
Palma plicata... 2.26 sccecess 6, 66 
Parametritis, chronic ........ 348 
Paraplegia ante-partum........ 99 
etiology......... 4000000 . 100 
GOUESO jae nicl « clolisivielelas=ta\e's 101 
Glesth ary S Sao Aasdancoodc 100 
SY MAPUOWIS! ele elelaretetelel= sic1-)=- 101 
(HHEMAME MG aaoac c@oodeaae 102 
Paresis, parturient..........- 303 
SEhLOlLOL ye ertele teeieieleiaieistele = 354 
COMLSC ioc oversioisisieielatoioiteisie sie 361 
NiStOGy sets csierereeseisisiVeler= 353, 308 
PEOLTIOSIS 6. lec cewccinne 363 
pathological anatomy.... 364 
prophylaxis ............. 366 
SyYMptoMs .....+eeee sees 360 
TreabMeNnth) \sc erie ier epolove = = 366 
Parturient passage, abnormal- 
AICS ATU ecteeisesictroiete ats eels eres 17 
Parturition, abnormal........ 144 
mechanism of.......... 54, 59 
normal, treatment ....... 72 
Paris aa UUTUS slelelcl-leleleiel-l-s1* 107 
preematurus.......--.-.+> 107 
iPelkate Gaels 6 sqgoondpAcasoeT 46 
rhteineathon Sano gOOdOAOS 46, 48 
aiidaynsseédoon paagopeuTe 46 
CNMETISIONS es araicrs aiacistel tse 47, 59 
(COMAPICTIOM ss cio 0-1-0 ele ele) 170 
symptoms..........- 171 
treatment ........... 172 
ligaments, falling in of... 64 
Pelvimetry .......0+ «...-+- 49, 55 
Rolivissanertietanticletsisieie stetere ole. 47 
at different ages........-. 52 
HULACHULOSaateleteleleleleleinie'e'sle s's 54 
CKOStOSOS .<secce cece cece 54 
IRGYOMElUB\ieaiesily sciccka's eve. 200 
Perosomus elumbus.........-. 204 
IPORSATIOS co ietisisieeisiarvniciestertelsts 820 
Phlegmon, puerperal......... 336 — 
PTLOLOLYign'scsieis wwe woe 0 336 





PAGE 
Phlegmon, puerperal, defini- 
GLOMUS OLi. cies siete cipietel seria ols 336 
SYTOPLOMS a0 wininnonie lee = 337 
treatment... 26 12 5.0<.-<. 338 
Placentaaeanicc<ciceieepe ieee 81 
GISGASCS tp ateis ote lesiste erate aie 132 
hemorrhage ..........5-5 133 
inflammation ........ 133, 135 
FOSPITALON Ss. pee eae 28 
BEC UU saci alanis hola isionts 133 
BY MUP DOMIS o(otclarsiatelatetelioleets 133 
LLECALIMENU. orcs wleicis'siis aiols 134 
tumors’.....- Root SGodecoc 133 
Placenta materna..........- 10, 18 
WAU Lesa oppieelere ial 11 
pC Bema eines Ps cyte 12 
ACCEESOLYscrerstaisiadoreitetetaners 13, 18 
foetal ashceek erecta storie 14, 16 
Plagues. sets sete als SHosobec 20 
BolyarthritiSeec siete Saray SO 
IBOLYMIGIUST. see sieictetsieieratelelmiarersiste 200 
Porta hepatica.........eeerce 26 
POTtaMtiSSUTer lets) sielatele Wasrccrles 
VOL Aerotatcictets\cleoxs aleterateiicreabe 7 
Post-partum period .......... 76 
Pregnancy, extra uterine..... 140 
GIASNOSIS tice. erelariace slots 33 
differential diagnosis..... 42 
Gurahloniol sites cette 43 
examination fOY. . c= <1le 36 
influence on diseases ..... 44 
internal examination..... 40 
rarllinhey Varnes o Agro wove 31 
secondary foetal......... 142 
Presentations, classification... 2382 
Prolapsus vaging............ 57 
bladd ora u erick sets 57 
Prosopo-thoracopagus.......- 200 
PUDONG Vistar so wees ele ee raieies tate 1 
Pulmonary artery ........... 28 
BY QODAL UR cin «vise evvleisrerem micteions 205 
TA VOCOMMOSas sin’ iter eintard’ePeisistalas 6 
TRAVELER. 5 cw oni ae bei Uap ee ns 228 


Reposition instruments......+ 227 


INDEX 383 


PAGE PAGE 
Respiration, how to start... 78 Tympanites ....ssereeeeeeere 73 
Retroversion of foetus.....++. 167 
Rutting ....cssecsssevcvesses 88 Udder, swelling of... .35, 36, 89, 90 

examination of........-.- 38 

Sacrum, dislocation of ....... 54 Umbilical arteries ..........- 22 
Salpingocyesis......++seeeeee> 141 VELTIS o's, dreteie <isis eM" Nica oti 22 
Sapreemia......+-++- santoteleaiien COL WEBIClelacieerce sicie tele'sie sieia's 15, 21 
Schistosoma reflexum........ 201 COLDS staisiode ease on, cleies sce 16, 22 
Schmidt-Miilheim theory..... 84 Uterine milk........s0ceeeees 18 
Septiczemia, acute puerperal.. 341 muscle cells....+..++-+++- 9 
definition .......+++-- 341 POTS: 5/seis scraveinis oles's eo slnweela 7 
cetiology...se+++ .-. O41 atony Of .....-+sceseee- 62, 181 
SYMPtOMS......-++0 . 341 treatment........++-- 182 
pathological anatomy 342 amputation Of.......+-+++ 322 
treatment..........-- 343 operation ....+++++++- 323 
puerperal ......-+.+eeeee- 84 anteversion of........-++- 144 
Sprains during birth......... 294 etiology ....csseceees 145 
GANSOS Shenae ete suet 294 treabmenties scsi sles ac 149 
SYMptOMs......eeeeeeees . 294 contractions of ........-. 60 
treatment......seseccceee 290 hernia: Of: <<) recec ese «00 105 
Still bulling. ........ Seaharaeet we PIrOgnosis .....0..---- 106 
Sternopagus........ AACE ee al, FTCALMENMT. «1c cielo ee'el! «16 106 
Superfecundation........+. males a0 hypertrophy of......-++-- 8 
Superfoetation ......-+++-+- See 20 injuries Of .......0..2+++5 299 
Suture, labial........... See ero treatment... .....0+..- 300 
PIN Goes ccleveeies Boe eer) inversion Of.......-0..-:- 309 
Synkephalus.........- Jeotaicre sy OUd) CAUSES! 2 ciarejs!eiviere n-ne 310 
Synovitis, metastatic ......-- 348 symptoms.........-- 312 
Symphysis pelvis......seseeee 47 TLEALIMEMD <\c101 sv «oe <1 315 
involution of..........- 81, 84 

Temperature of the newly paralysis of .........-.+-- 62 
[bernie SR Oe se eleaatsisin.sis) ese prolapsus of.......-.++++- 309 
Tetanus uteri......-2-+0- sreyeretan Or torsion Of ........0.see--- 144 
Thoracopagus.....-- Sis waives UG eetiology.......eee-+s 152 
Throes, dilatory ........-.+++ 69 ANIAOMWUY, 4 cleicis cic else elele 150 
Thymus .........-. CONOR Cra. GinectiONN.. <6 «eso 154 
Tocograph ......+sseee-- Po cove frequency......+--:-- 151 
Torsio uterl.”........ tienes . 149 HIStOPY ic: os ic evrelsle ne) 149 
Traction, amount of.......... 74 pathological anatomy 159 
@ivection os ccess 6 ccc seeee, 14 symptoms ........+.+> 155 
PPCUSSis ew cicisds'nclwiseis'se duieleieie ose OSL treatment.......-+e0 160 
Tuberculosis..... Sbaone wilets oa oe weight of ......eeseceeees 85 
Tumors; vaginal... s.0...<.%: 2/5 TEACH US) sock oalae'se claieieleleseres 21 
Tunica ovi intima........... 19 persistence Of .....++++++- 370 


Sat RRO Oe CHRO Le 


384 
PAGE 
Vagina, abnormalities of..... 179 
ATLJUTIGS Obie = cio Wale since es 300 
inversion of....... saHeene 91 
Prolapsus il 3.)5 coniiiesiene 91 
-anatomy of........ demos MO 
BUEOIOLY » «soc vv wsine Soe te 
symptoms ....... Satie oe 
differential diagnosis. 94 
treatment........ Slee LD 
Vaginal adhesions ........... 5 
Vaginismus......... simarels sisiorae RO 
WARIS: 6 i.0's cinireid relate scot 180 
Vulva, abnormalities......... 179 


IAGUTIOSs  cinislevie sicieeleiwen TOOL 


INDEX 


| PAGE 
Vulva, mucous discharge.,.... 65 
GWHULIN Sins wads Sdsemamanas MO 
Vulvo vaginal glands......... 5 
Vein, umbilical.)....... ines Tad 
Vernix caseosa..... pioixia pivayetal kOe 
Vitelline membrane.......... 3 
SielAE Heo eseslnatencmatacael Mae 
Wrater-bag ss ciccecveasia Saaateo pasts 66 
Wharton’s gelatine........... 22 
Xyphopagus,........ PASSE SSR ZN 
Zona pellucida... seccccessse _ 3 


WILLIAM R. JENKINS’ 
VETERINARY BOOKS 


1901 


(*) Single asterisk designates New Books. 
' (**) Double asterisk designates Recent Publications. 


For extended notices, sce the special advertise- 
ments at the back of the Catalogue. 





ANDERSON. “Vice in the IHlorse” and other papers 
on Horses and Riding. By FE. L. Anderson. Demy, 
SWORE LO Ulleerae eters totes sr Pere, ste cnttite chats etetionece.c eral 2 00 


— “How to Ride and School a Horse.” With a System 
of Horse Gymnastics. By Edward L. Anderson. 


ARMSTEAD. “The Artistic Anatomy of the Horse.” 
A brief description of the various Anatomical Struc- 
tures which may be distinguished during Life through 
the Skin. By Hugh W. Armstead, M.D., F.R.C.S. 
With illustrations from drawings by the author. 
Cloth obloney T2t& LO cece cen cwecwse 3 75 


BA CH, 


Veterinary Catalogue of William R. Jenkins 


“How to Judge a Horse.” A concise treatise 
as to its Qualities and Soundness; Including Bits and 
Bitting, Saddles and Saddling, Stable Drainage, Driv- 
ing One Horse, a Pair, Four-in-hand, or Tandem, ete. 
By Captain F.W. Bach. 12mo, cloth, fully illustrated, 
P1200 Papers «cnccs se ceees oom eee en ee Re ere 50 


()BANHAM. ‘Anatomical and Physiological Model of 


the Horse.’ Half life size. Composed of super- 
posed plates, colored to nature, showing internal 
organs, muscles, skeleton, etc., mounted on strong 
boards, with explanatory text. By George A. 
Banham, F.R.C.V.S. 

SizemMlodel 38x41 inches «nyse ee rae alee 10 00 


— “Tables of Veterinary Posology and Therapeuties,”’ with 


weights, measures, ete. By George A. Banham, 
F.R.C.V.S. New edition will be ready in March 1901. 
12705; C) ObHi x. Seer. athe cote ae core = one eras Se 1 00 


BAUCHER. ‘Method of Horsemanship.” Including 


the Breaking and Training of Horses............ 1 00 


(*)BELL. ‘The Veterinarian’s Call Book (Perpetual).” 


By Roscoe R. Bell, D.V.S., editor of the American 
Veterinary Review. Revised for 1901, 


A visiting list, that ean be commenced at any time 
and used until full, containing much useful informa- 
tion for the student and the busy practitioner. 
Among contents are items concerning: Veterinary 
Drugs; Poisons; Solubility of Drugs; Composition of 
Milk, Bile, Blood, Gastrie Juice, Urine, Saliva; Respi- 
ration; Dentition; Temperature, ete., ete. Bound in 
flexible leather, with flap and pocket Watare daatereistais 1 26 


851-853 Sixth Avenue (cor. 48th St.), New York. 3 


(“)\BRADLEY. ‘Outlines of Veterinary Anatomy.” 
By O. Charnock Bradley, Member of the Royal Col- 
lege of Veterinary Surgeons; Professor of Anatomy 
in the New Veterinary College, Edinburgh. 

The author presents the most important facts of 
veterinary anatomy in as condensed a form as possible, 
consistent with lucidity. 12mo. 


Complete in three parts. 


PART let ee NieL suMmOSE (ClOUM) eects elects eters heist. eter 1 25 
AG MiSs UND GUAT (\eane)) 2 oa ous soopuaubooUD 1 25 
Part III.: The Head and Neck (paper).......... 1 25 
J NIH aoe WIE a Cog ednnal Coe pOCOROOCOOOOD 3 50 


CADIOT. ‘*Roaring in Horses.” Its Pathology and 
Treatment. This work represents the latest develop- 
ment in operative methods for the alleviation 
of roaring. Each step is most clearly defined by 
excellent full-page illustrations. By P. J. Cadiot, 
Professor at the Veterinary School, Alfort. Trans. 
Thos. J. Watt Dollar, M.R.C.V.S., ete. Cloth..... 75 


— “Exercises in Equine Surgery.” By P. J. Cadiot. 
Translated by Prof. A. W. Bitting, M.D.,V.S. ; edited 
by Prof. A. Liautard, M.D.V.S. 8vo, cloth, illus- 
{Woz Re0 agen Gte Choe CICS GciOIne TR ROIS HOCUS ete pores 2 50 


(*)—** A Treatise on Veterinany Therapeutics of the Domestic 
Animals.” By P.J. Cadiot and J. Alvary. Translated 
by Prof. A. Liautard, M,D.,V.S. 2 Parts ready. 

Part I, Vol. I, 8vo, 93 pages, 45 illustrations......1 00 
artelleaVolesle) SVO, 960 PaASeS vaeijs lacie ee clslereie ws 1 00 
(Part IIT, in Preparation). 


4 Veterinary Catalogue of William R. Jenkins 


()\CHAPMAN. ‘Manual of the Pathological Treatment 
of Lameness in the Horse,’ treated solely by 
mechanical means. By George T. Chapman. 8vo, 
cloth 124 paces. is. 2 es rer eee ee eee 2 00 


CHAUVEAU. “The Comparative Anatomy of the 
Domesticated Animals.” By A. Chauveau. New 
edition, translated, enlarged and entirely revised by 
George Fleming, F.R.C.V.S.  8vo. cloth with 585 
Illustrations ..... MSs SOE ONE oa Ab .6 25 


CLARKE. “Chart of the Feet and Teeth of Fossil 
Horses: By W.-H. Clarkes. = oc. se ees 2D 


CLEMENT. ‘** Veterinary Post Mortem  Examina- 
tions.’ By A. W. Clement, V.S. Records of 
autopsies, to be of any value, should accurately 
represent the appearances of the tissues and organs 
so that a diagnosis might be made by the reader were 
not the examiners’ conclusions stated. To make the 
pathological conditions clear to the reader, some 
definite system of dissection is necessary. The 
absence in the English language, of any guide in 
making autopsies upon the lower animals, induced 
Dr. Clement to write this book, trusting that it 
would prove of practical value to the profession. 
12mo, Glotlh; illustrates. er eeee siete wate stint es 75 


CLEAVELAND. “Pronouncing Medical Lexicon.” 
Pocket edition.) (Clothites acme occsts innit eters 76 


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COURTENAY. “Manual of Veterinary Medicine and 
Surgery.” By Edward Courtenay, V.S. Crown, 8vo, 


COX, ‘““Horses: In Accident and _ Disease.” The 
sketches introduced embrace various attitudes which 
have been observed, such as in choking ; the disorders 
and accidents occurring to the stomach and intestines ; 
affection of the brain ; and some special forms of lame- 
ness, etc. By J. Roalfe Cox, F.R.C.V.S.  8vo, cloth, 
fullivsilliistratediees sera <tsictaice cl cicie’s carseeres et es 1 £0 


CURTIS. ‘Horses, Cattle, Sheep and Swine.’ The 
origin, history, improvement, description, characteris- 
tics, merits, objections, ete. By Geo. W. Curtis, 
M.S.A. Superbly illustrated. Cloth, $2 00; half 
SNEED Oat Oswalt MMNOLOCCOM ts ilese eles ssice one ee « 3 50 


(*)DALRYMPLE. “Veterinary Obstetrics.” A compen- 
dium for the use of advanced students and Practi- 
tioners. ‘Biveen\\ em eee alex my ples Nilesh. Cap Vin Sus 
principal of the Department of Veterinary Science in 
the Louisiana State University and A. & M. College; 
Veterinarian to the Louisiana State Bureau of 
Agriculture, and Agricultural Experiment Stations ; 
Member of the United States Veterinary Medical 
Associations, ete. 8vo, cloth, with many illustra- 


6 Veterinary Catalogue of William R. Jenkins 


DALZIEL. ‘The Fox Terrier.” Illustrated. (Monographs 
on British Dogs). By Hugh Dalziel............. 1 00 


=< Phe St. Bernard. Llustrated 25.2 .> aoc ee veacleece e 1 00 


— “The Diseases of Dogs.” Their Pathology, Diagnosis 
and Treatment, with a dictionary of Canine Materia 


Medica. By Hugh Dalziel. 12mo, cloth............. 80 
— Diseases of Horses.” 12mo, cloth... ............ ecee 1 00 
— “Breaking and Training Dogs.” Being concise 


directions for the proper education of dogs, both 
for the field and for companions. Second edi- 
tion, revised and enlarged. Part I, by Pathfinder; 
Part If, by Hugh Dalziel. 12mo, cloth, illus....2 60 


— “The Collie.” Its History, Points, and Breeding. By 
Hugh Dalziel Illustrated, 8vo, cloth............ 1 00 


— “The Greyhound.” 8vo, cloth, illus... .............4.. 1 00 


DANA. ‘Tables in Comparative Physiology.” By Prof. 
O! DL. Dana; MoD con stib ae omecs ae emeeme neers 25 


DANCE. ‘Veterinary Tablet.” Folded in cloth case. 
The tablet of A. A. Dance is a synopsis of the diseases 
of horses, cattle and dogs, with the causes, symptoms 
ONG: CULES iawis sore erent ites oe alelvtaisin ate ate Gaeey eictaleretelin ees 76 


DAY. “The Race-horse in Training,’ By Wm. Day, 


851-853 Sixth Avenue (cor. 48th St.), New York. 7 


(*)DE BRUIN. ‘Bovine Obstetries.”” By M. G. De Bruin, 
Instructor of Obstetrics at the State Veterinary 
School in Utrecht. Translated by W. E. A. Wyman, 
Professor of Veterinary Science at Clemson A. & M. 
College, and Veterinarian to the South Carolina 


Experiment Station. 
Svo, cloth, 382 pages, 77 illustrations............5 00 


See also ‘* Wyman.” 


()DOLLAR. ‘A Surgical Operating Table for the 
Horse.”? By Jno. A. W. Dollar, M.R.C.V.S..... 0 90 


(*)— **Clinical Veterinary Medicine and Surgery.” By John 
ASW DO ll ar mV On VieSe nie eee. oni ttn k iol io. 5 25 


(*)— “A Hand-book of Horse-Shocing,” with introductory 
chapters on the anatomy and physiology of the 
horse’s foot. By Jno. A. W. Dollar, M.R.C.V.S., 
translator and editor of Mdller’s ‘“ Veterinary Sur- 
gery,’ ‘‘An Atlas of Veterinary Surgical Operations,” 
ete.; with the collaboration of Albert Wheatley, 
F.R.C.V.S. 8vo, cloth, 433 pp., 4C6 illustrations . .4.75 


DUN. “Veterinary Medicines.” By Finlay Dun, V. 8. 
A new revised and enlarged English edition 
(temporarily out of print), 8vo, cloth ............3 50 


DWYER. ‘Seats and Saddles.” Bits and Bitting, 
Draught and Harness and the Prevention and Cure of 
Restiveness in Horses. By Francis Dwyer. TIllus- 
trated. Lvolewlamo, Clothsmlt: so.) 25. esc.. soe 1 50 


8 Veterinary Catalogue of William R. Jenkins 


FLEMING, “Veterinary Obstetrics.” Including the 
Accidents and Diseases incident tu Pregnancy, Parturi- 
tion, and the early Age in Domesticated Animals. 
By Geo. Fleming, F.R.C.V.S. With 212 illustrations. 
New edition revised, 226 illustrations, 758 pages...6 25 
773 pages, 8vo, cloth (old edition)...... seaitan et in 3 50 


’ 


— “Tuberculosis.” From a Sanitary and Pathological Point 
of View. By Geo. Fleming, F.R.C.V.S. ..:....... 26 


— “The Contagious Diseases of Animals.” Their influence on 
the wealth and health of nations, 12mo, paper... .25 


— ‘Operative Veterinary Surgery.” Part I, by Dr, 
Geo. Fleming, M.R.C.V.S. This valuable work, 
the most practical treatise yet issued on the 
subject in the English language, is devoted to the 
common operations of Veterinary Surgery; and the 
concise descriptions and directions of the text are illus- 
trated with numerous wood engravings. 8vo,cloth.2 75 


Second volume in preparation. 


— ‘Human and Animal Variole.” A Study in Comparative 
Patholopy;; = Papers4.50 «skeet ae aoe a ee 25 


— “Animal Plagues.” Their History, Nature, and 
Preventior, By George Fleming, F, R. C. V.S., ete. 
First Series. 8vo, cloth, $6.00; Second Series. 
8vo, cloth 


— “Roaring in ILorses,” By Dr. George Fleming, 
F.R.C.V.S. A treatise on this peculiar disorder 
of the Horse, indicating its method of treatment 
and curability. 8vo, cloth, with col. plates 


851-853 Siath Avenue (cor. 48th St.), New York. 9 


FLEMING-NEUMANN. “Parasites and Parasitic 
Diseases of the Domesticated Animals.” A work 
which the students of human or veterinary medi- 
cine, the sanitarian, agriculturist or breeder or rearer 
of animals, may refer for full information regarding 
the external and internal Parasites—vegetable and 
animal—which attack various species of Domestic 
Animals. A Treatise by L. G. Neumann, Professor 
at the National Veterinary School of Toulouse, 
Translated and edited by George Fleming, C. B., L.L. 
D.,F.R.C.V.S. 873 pages, 365 illustrations, cloth.7 50 


GRESSWELL. ‘The Diseases and Disorders of the 
Ox.” By George Gresswell, B.A. With Notes by 
James B. Gresswell. Crown, 8vo, cloth, illus....3 50 


— “Diseases and Disorders of the Horse.” By Albert, 
James B., and George Gresswell. Crown, 8vo, illus- 
Eel Cid a soooensomranondsooa coos udooBonEod 1 75 


— “Veterinary Pharmacology and Therapeutics.” By 
James B. Gresswell, F.R.C.V.S. 16mo, cloth ...1 60 


— “<The Bovine Preseriber.” For the use of Veterina- 
rians and Veterinary Students. By James B. and 
Albert Gresswell, M.R:C-V.S Cloth. -............. 75 


— “<The Equine ‘Hospital Preseriber.”|| Drawn up for the 
use of Veterinary Practitioners and Students. By 
Drs. James LB. and Albert Gresswell, M.R.C.V.S. 


CloUnA eee oe Ath 8 Bid tbh UO RE eet Re a 


or 


10 Veterinary Catalogue of William R. Jenkins 


GRESSWELL. Manual of “The Theory and Practice 
of Equine Medicine.” By J. B. Gresswell, F.R.C.V.S., 
and Albert Gresswell, M.R.C.V.S., second edition, 
enlarged, -Svo0; Cloths: ss. cj oe > wisest eee ae 2 75 


— “Veterinary Pharmacopwia, Materia Medica and 
Therapeutics.” By George and Charles Gresswell, 
with descriptions and physiological actions of medi- 
cines. By Albert Gresswell. Crown, 8vo, cloth. .2 75 


GOTTHEIL. ‘A Manual of General Histology.” 
By Wm. S. Gottheil, M.D., Professor of Pathology in 
the American Veterinary College, New York; etc., ete. 

Histology is the basis of the physician’s art, as 
Anatomy is the foundation of the surgeon's science. 
Only by knowing the processes of life can we under- 
stand the changes of disease and the action of remedies; 
as the architect must know his building materials, so 
must the practitioner of medicine know the intimate 
structure of the body. To present this knowledge in 
an accessible and simple form has been the author's 
task. 8vo., cloth, 148 pages, fully illustrated... 1 (0 


HASSLOCH. “A Compend of Veterinary Materia Medica 
and Therapeutics.” By Dr. A. C. Hassloch, VS., 
Lecturer on Materia Medica and Therapeutics, and 
Professor of Veterinary Dentistry at the New York 
College of Veterinary Surgeons and School of Compa- 


rative Medicine, N. Y. 12mo, cloth, 225 pages ..1 50 


851-853 Siath Avenue (cor. 48th St.), New York. 11 


HEATLEY. ‘The Stock Owner’s Guide.” A handy 
: Medical Treatise for every man who owns an 
ox or cow. By George S. Heatley, M.R.C.V. 12mo, 


— “The Horse Owner’s Safeguard.” A handy Medical 
Guide for every Horse Owner. 12mo, cloth..,...1 60 


— ‘Practical Veterinary Remedies.” 12mo, cloth.........1 00 


HILL, “The Management and Diseases of the Dog.” 
Containing full instructions for Breeding, Rearing and 
Kenneling Dogs. Their Different Diseases. How to 
detect and how to cure them. Their Medicines, and 
the doses in which they can be safely administered. 
By J. Woodroffe Hill, F.R.C.V.S. 12mo, cloth, extra 
HOM a TER Hoan saw goeceeGodEanoodnouCcs eee a00 
(Temporarily out of print, new edition in preparation.) 


HINEBAUCH. “Veterinary Dental Surgery.” For the 
use of Students, Practitioners and Stoeckmen, 
1moelobhsilustraheds).cace tems eee se crews 2 00 


HIOARE. “A Manual of Veterinary Therapeutics and 
Pharmacology.” By E. Wallis Hoare, F.R.C.V.%. 
12MoOTClOths oOUspA ese er me ys otek ieee se 0D 


“Deserves a good place in the libraries of all veterina- 
rians. * * * Cannot help but be of the greatest assist- 
ance tothe young veterinarian and the every day busy 
practitioner.”—American Veterinary Review, 


Veterinary Catalogue of William R. Jenkins 


‘\HOBDAY. ‘Canine and Feline Surgery.”? By Frederick 


T. G. Hobday, F.R.C.V.S., Professor in Charge of the 
Free Out-Patients’ Clinique at the Royal Veterinary 
College, London, The work contains 76 illustrations 
in the text. 

Demy 8vo, 152 pages, full-bound cloth ........... 2 00 


*\)HUNTING. The Art of Horse-shoeing. A manua 


for Farriers. By William Hunting, F.R.C.V-S., edi- 
tor of the Veterinary Record, ex-president of the Royal 
College of Veterinary Surgeons. 8vo, cloth, with 
nearly, LOOM us trations: 22 eee. seis se ete eae 1 00 


\JENKINS. ‘Model of the Horse.”............. 10 00 


(See Banham). 


(“)KOBERT, “Practical Toxicology for Physicians and 


KOCH, 


Students,’ By Professor Dr. Rudolph Kobert, 
Medical Director of Dr. Brehmer’s Sanitarium for 
Pulmonary Diseases at Goerbersderf in Silesia (Prus- 
sia), late Director of the Pharmacological Institute, 
Dorpat, Russia. Translated and edited by L. H. 
Friedburg, Ph. D. Authorized Edition. 

SVO; 'CLOLN Set Carew cats conte an wreteaiee ts its crre lem ae 2 50 


** Etiology of Tubereulosis.”? By Dr. R. Koch. 
Translated by T. Saure. 8vo, cloth.............1 (0 


851-853 Sixth Avenue (cor. 48th St.), New York. 13 


KEATING. “A New Unabridged Pronouncing Diction- 
ary of Medicine.” By John M. Keating, M.D., LL.D., 
Henry Hamilton and others. A voluminous and 
exhaustive hand-book of Medical and _ scientific 
terminology with Phonetic Pronunciation, Accentu- 
ation, Etymology, etc. With an appendix containing 
important tables of Bacilli, Microcci Leucomaines, 
Ptomaines; Drugs and Materials used in Antiseptie 
Surgery; Poisons and their antidotes ; Weights and 
Measures; Themometer Seales; New Officinal and 
Unofficinal Drugs, ete., etc. S8vo, 818 pages..... 5 00 


LAMBERT. “The Germ Theory’ of Disease.” 
Bearing upon the health and welfare of man and the 
domesticated animals. By James Lambert, F.R.C.V.S. 
SVOR MMOL ocr cir. totic cite weieuer ao Sold oi arche « Sistareeterairs cies 25 


LAW. ‘*¥Farmers’ Veterinary Adviser.”’ A Guide to 
the Prevention and Treatment of Disease in Domestic 
Animals. By Professor James Law. Illustrated. 8vo, 


()LEGGE,. “Cattle Tuberculosis.” A Practical Guide 
tothe Farmer, Butcher and Meat Inspector. By T.M. 
Legge, M.A,, M.D., D.P.H., Secretary of the Royal 
Commission on Tuberculosis, 1896-98; author of 
‘“« Public Health in European Capitals,” and ‘‘ Harold 
Sessions Hon ACLVeSsn Cloths. soc ete cre wise seca ee 1 00 


14 Veterinary Catalogue of William R. Jenkins 


LIAUTARD, ‘Median Neurotomy in the Treatment of 
Chronic Tendinitis and Periostosis of the Fetlock.” 
By C. Pellerin, late Repetitor of Clinic and Surgery to 
the Alfort Veterinary School. Translated with addi- 
tional facts relating to it, by Prof. A. Liautard, M.D., 
V.M. 


Having rendered good results when performed by 
himself, the author believes the operation, which 
consists in dividing the cubito-plantar nerve and in 
excising a portion of the peripherical end, the means 
of improving the conditions, and consequently the 
values of many apparently doomed animals. Agricul- 
ture in particular will be benefited. 

The work is divided into two parts. The first covers 
the study of Median Neurotomy itself; the second, 
the exact relations . ofthe facts as observed by the 
AUtHOLwoVO.. DOBLOSo-7 acess eon oe eee 100 


— **Manual of Operative Veterinary Surgery.” By A. 
Liautard, M.D., V.M., Principal and Professor of 
Anatomy, Surgery, Sanitary Medicine and Juris- 
prudence in the American Veterinary College; 
Chevalier du Merite Agricole de France, Honorary 
Fellow of the Royal College of Veterinary Surgeons 
(London), ete., ete. 8vo, cloth, 786 pages and nearly 
LOO WU HEROS 66 Add Sed cS adda Gabandad jane 3405 6 00 


— ‘*tAnimal Castration.”? A concise and practical Treatise 
on the Castration of the Domestic Animals. The 
only work on the subject in the English language. 
Illustrated with forty-four cuts. 12mo, cloth...2 00 


— ‘**Vade Mecum of Equine Anatomy.’’ By A. Liautard, 
M.D.V.S. Dean of the American Veterinary College, 
12mo, cloth. New edition, with illustrations. ...2 00 


851-853 Sixth Avenue (cor. 48th St.), New York. 15 


LIAUTARD. ‘6 Translation of Zundel on the Horse’s 
DPT eet Amek 6) Ko ates eS aid bo peO AORISOE Fp eS ee eS 2 00 


— *How to Tell the Age of the Domestic Animal.” By 
Dr. A. Liautard, M.D., V.S.  Profusely illustrated. 
D2 Pelothremcstsrevelalaie clerare eistelctare)elesolisielele’s el siete «/esese "= 60 


— ‘Qn the Lameness of Horses.”’ By A. Liautard, 
1 BE Date ee es od oGbbUge ap oo Doe MOUOIOd ar acrn Oobeae 2 50 
See also ‘‘Cadiot’s Surgery.” 


(*)--** A Treatise on Veterinary Therapeutics of the Domestic 
Animals.”’ (See Cadiot,) 


LONG. “Book of the Pig.” Its selection, Breeding, 
Feeding and Management. 8vo, cloth........... 4 25 


(LOWE. ‘* Breeding Racehorses by the Figure 
System.”? Compiled by the late C. Bruce Lowe. 
Edited by William Allison, ‘‘ The Special Commis- 
sioner,” London Sportsman, Hon. Secretary Sporting 
League, and Manager of the International Horse 
Agency and Exchange. With numerous fine illustra- 
tions of celebrated horses. Quarto, cloth....... 7 50 


LUDLOW. ‘Science in the Stable ’’; or How a Horse can 
be Kept in Perfect Health and be Used Without 
Shoes, in Harness or under the Saddle. With the 
Reason Why. Second American Edition. Enlarged 
and Exemplified. By Jacob R. Ludlow, M.D. Late 
Staff Surgeon, U.S. Army. Paper, 166 pages...... 50 


16 Veterinary Catalogue of William R, Jenkins 


LUPTON. **Horses: Sound and Unsound,” with 
Law relating to Sales and Warranty. By J. Irvine 
Lupton, F.R.C.V.S. 8vo, cloth, illustrated...... 1 25 


— **The Horse.”? As he Was, as he Is, and as he 
Ought to Be. By J. I. Lupton, F.R.C.V.S. Illus- 
Beabeds «Crown, -&V0 = assess we ereee cece ee eee 1 40 


MAGNER. ** Facts for Horse Owners.” By D. Magner. 
Upwards of 1,000 pages, illustrated with 900 engrav- 
ings. 8vo, leather binding. .......... ero, 7 50 


MAYHEW, **The Illustrated Horse Doctor.” An 
accurate and detailed account of the Various Diseases 
to which the Equine Race is subject ; together with the 
latest mode of Treatment, and all the Requisite Pre_ 
scriptions written in plain English. By E. Edward 
Mayhew, M.R.C.V.S. Illustrated. Entirely new 
edition; Sv0ClObhesc.naece ee oe boa stavahot etme 2 75 


McBRIDE. ‘Anatomical Outlines of the Horse.” 
12mo;"cloth. --Reduceduto <a. sees melieiciene 1 50. 


McCOMBIE. “Cattle and Cattle Bree¢ :rs.” Cloth....... 1 00 


MFADYEAN. ‘Anatomy of the Horse.” A _ Dis- 
section Guide. By J. M. M’Fadyean, M.R.C.V.S. 
This book is intended for Veterinary students, and 
offers to them in its 48 full-page colored plates numer- 
ous other engravings and excellent text, the most 
valuable and practical aid in the study of Veterinary 
Anatomy, especially in the dissecting room. 
Svo, Cloth * >. dork wasn eee es neds Ree Eee 5 50 


851-853: Sixth Avenue (cor. 48th St.), New York. fe. 


MFADYEAN. ‘** Comparative Anatomy of the Domes- 
ticated Animals.’ By J. M’Fadyean. . Profusely 
illustrated, and to be issued in two parts. 

Part I—Osteology, ready. Paper, 2.50; cloth... .2.75 
(Part II in preparation.) 


MILLS. ‘How to Keep a Dog in the City.”’ By 
Wesley Mills, M.D., V.S. It tells how to choose, 
manage, house, feed, educate the pup, how to keep him 
clean and teach im cleanliness. Paper........... 25 


MOLLER. “Operative Veterinary Surgery.” By Profes- 
sor Dr. H. Moller, Berlin. Translated and edited 
from the 2nd edition, enlarged and improved, by 
John A, W. Dollar, M.R.C.S. 

Prof. Moller’s work presents the most recent and 
complete exposition of the Principles and Practice of 
Veterinary Surgery, and is the standard text-book on the 
subject throughout Germany. 

Many subjects ignored in previous treatises on 
Veterinary Surgery here receive full consideration, 
while the better known are presented under new and 
suggestive aspects. 

As Prof. Moller’s work represents not only his 
own opinions and practice, but thoso of the best 
Veterinary Surgeons of various countries, the trans- 
lation cannot fail to be of signal service to American 
and British Veterinarians and to Students of Veter- 
inary and Comparative Surgery. 
1 vol.,8vo. 722 pages, 142 illustrations ........ 5 25 


MORETON. ‘On Horse-breaking.”? i2mo, cl......... 50 


18 Veterinary Catalogue of William R. Jenkins 


MOSSELMAN-LIENAUX. ‘* Veterinary Microbio- 
logy.’ By Professors Musselman and Liénaux, 
Nat. Veterinary College, Cureghem, Belgium. Trans- 
lated and edited by R. R. Dinwiddie, Professor of 
Veterinary Science, College of Agriculture, Arkansas 
State University. 12mo, cloth, 312 pages........ 2 00 


NOCARD. “The Animal Tuberculoses, and their Relation 
to Human Tuberculosis.” By Ed. Nocard, Professor 
of the Alfurt Veterinary College. Translated by 
H. Scurfield, M.D. Ed., Ph. Camb. 

Perhaps the chief interest to doctors of human 
medicine in Professor Nocard’s book lies in the 
demonstration of the small part played by heredity, 
and the great part played by contagion in the propa- 
gation of bovine tuberculosis. It seems not unreason- 
able to suppose that the same is the case for human 
tuberculosis, and that, if the children of tuberculosis 
parents were protected from infection by cohabitation 
or ingestion, the importance of heredity as a cause of 
the disease, or even of the predisposition to it, would 
dwindle away iato insignificance. 


12mo,, cloth, 143 pages « .. ©. cc se0eecen+ sees .1 00 


PEGLER. “The Book of the Goat.”’ 12mo, cloth.......1 75 


PELLERIN. ‘Median Neurotomy in the Treatment 
of Chronic Tendinitis and Periostosis of the Fetlock.” 
By C. Pellerin, late repetitor of Clinic and Surgery to 
the Alfort Veterinary School. Translated, with Addi- 
tional Facts Relating to It, by Prof. A. Liautard, M.D,, 


V.M, 8vo, boards, illustrated...........c005 os. 1 00 
See alsu ** Liaulard,” 


851-853 Siath Avenue (cor. 48th St.), New York. 19 


PETERS. ‘A Tuberculous Herd—Test with Tuber- 
culin.”’” By Austin Peters, M. R.C. V.S., Chief 
Inspector of Cattle for the New York State Board of 
Health during the winter of 1892-93. Pamphlet... .25 


\PFEIFFER-WILLIAMS. ‘A Course of Surgieal 
Operations for Veterinary Students and Practi- 
tioners.”’ By W. Pfeiffer, Assistant in the Surgical 
Clinic of the Veterinary High School in Berlin, and 
W. L. Williams, V.S., Professor of Surgery in the 
New York State Veterinary College, Cornell Univer- 
sity, Ithaca, N. Y. 

A concise description of the more common major 
surgical operations, designed as a laboratory guide in 
surgical exercises for veterinary students and as a 
ready reference for practitioners in surgical opera- 
tions. Based upon a translation of Dr. Pfeiffer’s 
‘‘Operations-Cursus,” embodying the experience of 
Dr. Pfeiffer and Prof. Dr. Froéhner in the Berlin 
Veterinary School. With numerous annotations there 
have been added many of the newer, largely distine- 
tively American, operations. 

With 42 illustrations, 12mo, cloth............... 1 25 


REYNOLD. “Breeding and Management of Draught 
HOTSOSss cov OR ClOth ie carves niotrceimelelemrteticerenn vc 1 40 


ROBERGE. ‘The Foot of the Horse,” or Lameness 
and all Diseases of the Feet traced to an Unbalanced 
Foot Bone, prevented or cured by balancing the foot. 
By David Roberge. 8vo, cloth.............0.06s 5 00 


20 Veterinary Catalogue of William R. Jenkins 


C)SEWELL. * The Examination of Horses as to Sound- 
ness and Selection as to Purchase.’ By Edward 
Sewell, M.R.C.V.S.L. 8vo, paper..............- 1 £0 


_... It is a great advantage to the business man to 
know something of the elements of law, and nobody 
ought either to buy or own a horse who does not know 
something about the animal. That something this book 
vives, and gives in a thoroughly excellent way.... 

Our Anmmal Friends, November, 1898. 


SMITH. ‘*‘A Manual of Veterinary Physiology.” By 
Veterinary Captain F. Smith, M.R.C.V.S. Author of 
‘©A Manual of Veterinary Hygiene.” 

Throughout this manual the object has been to con- 
dense the information as much as possible. The 
broad facts of the sciences are stated so as to render 
them of use to the student and practitioner. In this 
second edition—rewritten—the whole of the Nervous 
System has been revised, a new chapter dealing with 
the Development of the Ovum has been added together 
with many additional facts and illustrations. About 
one hundred additional pages ‘are given. Second 
edition, revised and enlarged, with additional illus- 
trations ye ctslsiet- ele Ne hclave othe alaierera atehalp tier stpinieralaistels mi 3 75 


— **Manual of Veterinary Hygiene.’ 2nd edition, revised. 
Crown; Svoy Clothes covers sicen tiettninentetnters 3 25 


(“*)STRANGEWAY. ** Veterinary Anatomy.” New 
edition, revised and edited by I. Vaughan, F.L.S., 
M R.C V.S., with several hundred illustrations. 
Sve. clothe 25.2.2 ha sta ments sales ieee na tein aeielare 5 00 


851-853 Sixth Avenue (cor. 48th St.), New York 21 


(**)SUSSDORF. ‘‘Large Colored Wall Diagrams.” By 
Professor Sussdorf, M.D. (of Géttingen). Text 
translated by Prof. W. Owen Williams, of the New 
Veterinary College, Edinburgh. Size, 44 inches by 


30 inches. 
1.—Horse. 4.—Ox. 
2.—Mare. 5.—Boar and Sow. 
3.—Cow. 6.—Dog and Bitch. 


Showing the position of the viscera in the large 
cavities of the body. 


PICO mM OUMLOM er etre le etait alee < ove .cle oir i> i < 1 75 each 
‘¢ mounted on linen, with roller... .... 350 ‘§ 


(*)VAN MATER, ‘A Text Book of Veterinary Oph- 
thalmology.”?> By George G. Van Mater, M.D., 
D.V.S., Professor of Ophthalmology in the American 
Veterinary College; Oculist and Aurist to St. Martha’s 
Sanitarium and Dispensary; Consulting Eye and Ear 
Surgeon to the Twenty-sixth Ward Dispensary ; Eye 
and Ear Surgeon, Brooklyn Eastern District Dispen- 
sary, ete. Illustrated by one chromo lithograph plate 
and seventy-one engravings, 8vo cloth..... .... 3 00 


VETERINARY DIAGRAMS in Tabular’ Form. 
Size, 284 in. x 22inches. Price per set of five... 4 75 


No.1. “The External Form and Elementary Ana- 
tomy of the Horse.” Eight colored illustrations— 
]. External regions; 2. Skeleton; 3. Muscles (Superior 
Layer); 4. Muscles (Deep Layer); 5. Respiratory Ap- 
paratus; 6. Digestive Apparatus; 7. Circulatory Ap- 
paratus ; 8. Nerve Apparatus ; with letter-press descrip- 
WOT Arye d bon GURIM ROG boned Sa COCO De Doo DOE OOEaor 1 25 


22 Veterinary Catalogue of William R. Jenkins 


No. 2. ‘The Age of Domestic Animals.” Forty-two 
figures illustrating the structure of the teeth, indicat- 
ing the Age of the Horse, Ox, Sheep, and Dog, with 
fullideseripti OM ese > wneisie at orale ocetelale miele sai aiela ee eet 73 


No. 3. ‘The Unsoundness and Defects of the Horse.” 
Fifty figures illustrating—1. The Defects of Confor- 
mation; 2. Defects of Position ; 3. Infirmities or Signs 
of Disease; 4. Unsoundnesses ; 5. Defects of the Foot; 
With filled escriptlon. jasc ereyect=-t- pelts ofelere erin eines 75 


No.4. ‘The Shoeing of the Horse, Mule and Ox.” 
Fifty figures descriptive of the Anatomy and Physio- 
logy of the Foot and of Horse-shoeing............. 75 


No. 5. ‘The Elementary Anatomy, Points, and But- 
cher’s Joints of the Ox.” Ten colored illustrations 
—1. Skeleton; 2. Nervous System; 3. Digestive 
System (Right Side); 4. Respiratory System ; 5. Points 
of a Fat Ox; 6. Muscular System ; 7. Vascular System; 
8. Digestive System (Left Side); 9. Butcher’s Sections 
of a Calf; 10. Butcher’s Sections of an Ox; with full 
GesEriIpMOD) 2... soca cmtarse orm laine, onl uterelanee ie eee +1 25 


WALLEY. “A Practical Guide to Meat Inspection.” By 
Thomas Walley, M.R.C.V.S., formerly principal of 
the Edinburgh Royal (Dick) Veterinary College; Pro- 
fessor of Veterinary Medicine and Surgery, ete, Third 
Edition, thoroughly revised, with forty-five colored 
{hustrablonsiyl 2m On GlO ue cen teeta ie erties 3 00 
Temporarily out of print. (4th edition in preparation.) 

An experience of over 30 years in his profession 
and a long official connection (some sixteen years) 
with Edinburgh Abattoirs have enabled the author to 
gather a large store of information on the subject, 
which he has embodied in his book. Dr. Walley’s opi- 
nions are regarded as the highest authority on Meat 
Inspection. 


851-853 Sixth Avenue (cor. 48th St.), New York 23 


WALLEY. ‘Four Bovine Scourges.” (Pleuro-Pneumonia, 
Foot and Mouth Disease, Cattle Plague and 
Tubercle.) With an Appendix on, the Inspection of 
Live Animals and Meat. Illustrated, 4to, cloth. .6 40 


WILLIAMS. “Principles and Practice of Veterinary 
Medicine.” New author’s edition, entirely revised 
and illustrated with numerous plain and colored 
plates. By W. Williams, M.R.C.V.S. 8vo., eloth. .6 00 


— “Principles and Practice of Veterinary Surgery.” New 
author’s edition, entirely revised and _ illustrated 
with numerous plain and colored plates. By W. 
Williams, M.R.C.V.S. 8vo, eloth............... 6 00 


(*) WILLIAMS - PFEIFFER. ‘A Course of Surgical 
Operations for Veterinary Students and Practi- 
tioners.». By W. Pfeiffer and W. L. Williams, V.S. 
With 42 illustrations, 12mo, cloth............... 1 25 

See also ‘‘Pfeiffer- Williams.” 


(*) WINSLOW, ‘Veterinary Materia Medica and Therapeu- 
tics.”?’ By Kenelm Winslow, B.A.S., M.D.V., M.D., 
(Harv.); Assistant Professor of Therapeutics in the 
Veterinary School of Harvard University; Fellow of 
tle Massachusetts Medical Society; Surgeon to the 
Newton Hospital, ete. 
Svo, cloth, 750 pages......- ce... ce+ se ee esses 6 00 


(**)\WYMAN. “The Clinical Diagnosis of Lameness 
in the Horse.” By W. E. A. Wyman, V.S., Prof. of 
Veterinary Science, Clemson A. & M. College, and 
Veterinarian to the South Carolina Experiment Sta- 
On eS VOn Clothe llNStratediese cm cl ccleiciciels'e ele 1+ oie 2 50 


24 Veterinary Catalogue of William R. Jenkins 


(*)WYMAN. ** Bovine Obstetrics.” By M. G: De Bruin, 
Instructor of Obstetrics at the State Veterinary 
School in Utrecht. Translated by W. E. A. Wyman, 
M.D.V., V.S., Professor of Veterinary Science, 
Clemson A. & M. College, and Veterinarian to the 
South Carolina Experiment Station. 
8vo, cloth, 382 pages, 77 illustrations... Ree 5 00 
See also ‘‘ De Bruin,” 


ZUNDEL. ‘The Horse’s Foot and Its Diseases.” By 
A. Zundel, Principal Veterinarian of Alsace Lorraine. 
Translated by Dr. A. Liautard, V.S. 12mo, cloth 
ANSEL ACSI: .crstore.wistelsinieie om nieietetsletele Ravstereseeiatalatages 2 00 


ZUILL. “Typhoid Fever; or Contagious Influenza 
in the Horse.” By Prof. W. L. Zuill, M.D.,D.V.S. 
Pam pnlet recite sie a piarat eters ies cetele tats nto (sin stele steers 26 





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